Are our patients becoming more complex? Trends in comorbidity and functional dependence in General Medicine 2011–2019

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Internal Medicine Journal Pub Date : 2024-09-10 DOI:10.1111/imj.16505

Stephanie J. Snedden, Paul Thein, Wee J. Chee, Julia Ong, Ralph Junckerstorff

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Abstract

Background

Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more ‘complex’.

Aims

The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period.

Methods

Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30-day readmission rate and inpatient mortality.

Results

There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries.

Conclusions

Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity.

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我们的病人是否变得越来越复杂？2011-2019 年全科医学中的合并症和功能依赖趋势

背景从轶事来看，患者似乎并不比 10 年前更加不适，但他们似乎仍然更加 "复杂"。研究目的本研究旨在使用客观测量方法评估 9 年间普通内科患者复杂性的变化趋势。我们选取了莫纳什医疗中心（澳大利亚墨尔本的一家三级医院）2011 年至 2019 年每年 4 月份连续出院的 100 名普通内科患者。我们对每位患者的合并症负担和依赖性/虚弱程度进行了回顾性计算。合并症使用夏尔森合并症指数（Charlson Comorbidity Index，CCI）进行测量，依赖性/虚弱程度使用卡茨日常生活活动独立性指数（Katz Index of Independence in Activities of Daily Living，Katz ADL）和布莱登量表（Braden Scale，BS）进行评估。BS 是一种压力损伤风险评估工具。此外，还收集了其他人口统计学数据，包括住院时间、入院和出院居住地、30 天再入院率和住院病人死亡率。但是，BS 中位数从 2011 年的 19 显著下降到 2019 年的 16（P = 0.006），反映出压伤风险增加。结论尽管合并症水平稳定，但我们发现 BS 分数在下降，这可能表明患者的依赖性在增加。依赖性的增加而非慢性疾病负担的变化可能是患者复杂性明显增加的原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.