Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009 / Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009

Introducción: Describir la complejidad clínica de los pacientes al ingreso en unidades de larga estancia sociosanitaria en Cataluña entre los años 2003 y 2009. Material y métodos: Análisis transversal de 47.855 ingresos registrados en el sistema de información Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris. Las variables analizadas fueron agrupaciones diagnósticas, las comorbilidades y los procedimientos médicos, estado funcional y cognitivo, categorías de uso de recursos del Resource Utilization Groups III (RUG-III), la cobertura y la intensidad de las terapias rehabilitadoras. Se realizó un análisis descriptivo de la información. Resultados: Las agrupaciones diagnósticas más frecuentes en el periodo de estudio fueron demencia y enfermedad cerebrovascular aguda, que mostraron un descenso continuado (descenso del 8,8 y el 2,3%). El mayor aumento correspondió a ingresos por descanso familiar y fractura (7,7% y 1,9%). El estado funcional y cognitivo promedio se mantuvo estable, aunque aumentó el porcentaje de individuos con dependencia en todas las actividades de la vida diaria. Las categorías RUG-III más frecuentes fueron rehabilitación, funciones físicas reducidas, complejidad clínica y cuidados especiales. Durante el periodo estudiado, la categoría «rehabilitación» se incrementó marcadamente (20,3%), mientras las otras categorías disminuyeron. Las terapias rehabilitadoras incrementaron su cobertura durante el periodo (20,8%), especialmente la fisioterapia (25,4%) y la terapia ocupacional (17,4%). Conclusiones: La complejidad clínica de la población atendida en unidades de larga estancia aumentó en el periodo 2003-2009. El uso de recursos y terapias indican un creciente esfuerzo rehabilitador, como posible respuesta a cambios en la complejidad clínica atendida, los estándares de práctica clínica o las prácticas establecidas en el registro y notificación de la información (AU)

Introduction: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. Material and methods: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. Results: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). Conclusion: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices (AU)

[Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009]. / Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009.

INTRODUCTION: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. MATERIAL AND METHODS: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. RESULTS: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). CONCLUSION: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices.