Eficiencia de las unidades geriátricas de agudos en los hospitales españoles / Efficiency of acute geriatric units in Spain hospitals

Objetivos Revisar los datos publicados de los hospitales españoles en los que se hayan realizado comparaciones entre las estancias de los pacientes ingresados en unidades geriátricas de agudos (UGA) y en otros servicios, mediante la utilización del sistema de Grupos Relacionados por el Diagnóstico (GRD) de clasificación de pacientes. Aportar la experiencia propia en este tema. Material y métodos Se revisaron los trabajos españoles recogidos en una revisión sistemática previa. Se añadió la casuística del hospital, se analizaron los episodios de los pacientes mayores de 74 años dados de alta durante 24 meses incluidos en los GRD más frecuentes. Se compararon las estancias de los pacientes en las UGA con los del resto de los servicios médicos de los hospitales y con el estándar de la comunidad autónoma correspondiente.Resultados Hay datos de 5 hospitales generales españoles. La comparación de las estancias muestra una reducción entre el 8 y el 19% en las UGA comparadas con las de los otros servicios de los mismos hospitales en pacientes similares. En un hospital, la reducción de la estancia media (EM) en geriatría llega al 21% en los mayores de 80 años. En 3 de los 4 hospitales en que se comparó con el estándar, la EM en la UGA fue menor en la mayoría de los GRD, con reducciones del 7 al 9%. Conclusiones Estos resultados permiten concluir que, sobre la base de los sistemas de clasificación y codificación habitualmente usados, las UGA españolas son más eficientes que el resto de los servicios en la hospitalización aguda de los ancianos(AU)

Objectives To review published data from Spanish hospitals in which comparisons had been made between the mean length of stay in patients admitted to acute geriatric units (AGU) and those admitted to other departments using the diagnosis-related groups (DRG) classification system and to describe our own experience. Material and methods The Spanish reports collected in a previous systematic review were reviewed. The case mix of our hospital was added by analyzing episodes in patients older than 74 years old discharged during a 24-month period and included in the most frequent DRGs. The length of stay in patients admitted to the AGU was compared with that in the remaining medical departments in the hospital and with the standard average stay in the corresponding autonomous region. Results Data were obtained from five Spanish general hospitals. The comparison revealed that the mean length of stay in the AGU was 8–19% shorter than that of similar patients in the other medical departments of the same hospitals. In one hospital, the reduction in the mean length of stay was 21% in patients older than 80 years. In three of the four hospitals where comparisons with the standard were performed, the mean length of stay in the AGU was lower for most of the DRGs, showing reductions of 7–9%. Conclusions These results allow us to conclude that, based on the commonly used patient classification and coding system, Spanish AGUs are more efficient than the remaining medical services in the acute hospitalization of elderly patients in our setting (AU)

[Efficiency of acute geriatric units in Spain hospitals]. / Eficiencia de las unidades geriátricas de agudos en los hospitales españoles.

OBJECTIVES: To review published data from Spanish hospitals in which comparisons had been made between the mean length of stay in patients admitted to acute geriatric units (AGU) and those admitted to other departments using the diagnosis-related groups (DRG) classification system and to describe our own experience. MATERIAL AND METHODS: The Spanish reports collected in a previous systematic review were reviewed. The case mix of our hospital was added by analyzing episodes in patients older than 74 years old discharged during a 24-month period and included in the most frequent DRGs. The length of stay in patients admitted to the AGU was compared with that in the remaining medical departments in the hospital and with the standard average stay in the corresponding autonomous region. RESULTS: Data were obtained from five Spanish general hospitals. The comparison revealed that the mean length of stay in the AGU was 8-19% shorter than that of similar patients in the other medical departments of the same hospitals. In one hospital, the reduction in the mean length of stay was 21% in patients older than 80 years. In three of the four hospitals where comparisons with the standard were performed, the mean length of stay in the AGU was lower for most of the DRGs, showing reductions of 7-9%. CONCLUSIONS: These results allow us to conclude that, based on the commonly used patient classification and coding system, Spanish AGUs are more efficient than the remaining medical services in the acute hospitalization of elderly patients in our setting.

Resultados asistenciales de las unidades geriátricas de agudos. Revisión sistemática / Measuring results in acute care for the elderly units. A systematic review

Fundamento: revisar de manera sistemática la información existente en la literatura científica sobre los resultados asistenciales de las unidades geriátricas de agudos (UGA) hospitalarias. Material y método: la estrategia de búsqueda incluyó la consulta en bases bibliográficas (MEDLINE, EMBASE, Dialnet y Cochrane Central Register of Controlled Trials), la revisión de los sumarios de 5 revistas de geriatría y la búsqueda retrospectiva de citas en los artículos existentes. Resultados: se encontraron 41 publicaciones con datos sobre resultados asistenciales de las UGA. De ellas, 21 cumplieron los criterios de inclusión. Éstas aportaron datos de 18 experiencias en 19 hospitales. Todos los trabajos, excepto uno, encontraron una reducción de la estancia media en las UGA respecto a la hospitalización en otros servicios. La reducción fue del 30 al 54% en los trabajos que analizaron muestras históricas, superior al 10% en la mayoría de los estudios de bases de datos hospitalarias y del 17 al 46% (p < 0,01) en los estudios de casos y controles. De los 5 estudios aleatorizados con grupo control, 2 mostraron reducciones significativas de la estancia media (del 19 y el 24%, p < 0,01); otros 2, tendencias en el mismo sentido (del 3 y el 12%, respectivamente), y, 1 incremento de la estancia (32%). Estos estudios encontraron tendencias a la reducción de costes, a menor institucionalización y a mejoría funcional en los pacientes de las UGA. Conclusiones: los estudios existentes muestran una reducción de las estancias de los ancianos hospitalizados por enfermedad aguda en unidades geriátricas respecto a la hospitalización convencional en otros servicios médicos. Esto supone un ahorro de recursos sin merma en la calidad asistencial. Debe plantearse la puesta en marcha de UGA en los hospitales donde no existan todavía

Background: the aim of this study was to perform a systematic review of the scientific information related to the results of in-hospital acute care for the elderly (ACE) units. Material and method: the search strategy included consultation of different bibliographic databases (MEDLINE, EMBASE, Dialnet and the Cochrane Central Register of Controlled Trials), review of the contents pages of five geriatric journals, and a retrospective search of the references in published articles. Results: forty-one articles with information on the results of ACE units were identified. Of these, only 21 met the inclusion criteria. These 21 articles provided data on 18 experiences in 19 hospitals. All the studies except one found a reduction in the mean length of stay in ACE units compared with conventional hospitalization. This reduction ranged from 30% to 54% in studies with historical samples, was more than 10% in hospital database studies, and ranged from 17% to 46% (P<.01) in case-control studies. Of 5 randomized controlled studies, 2 reported significant reductions in length of stay (19% and 24%, P<.01), another two studies reported trends in the same direction (3% and 12%) and 1 study found an increase in length of stay (32%) in the ACE unit. These studies reported tendencies towards reduced costs, lower institutionalization and functional improvement in patients admitted to ACE units. Conclusions: the studies performed to date show reductions in length of stay in elderly patients admitted to ACE units for acute illness compared with conventional hospitalization, leading to resource savings without decreasing the quality of care. The establishment of ACE units should be considered in hospitals without these units