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Article

Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study

by
Giuseppe A. Ramirez
1,2,3,*,
Sarah Damanti
2,3,
Pier Francesco Caruso
2,3,
Francesca Mette
2,3,
Gaia Pagliula
2,3,
Adriana Cariddi
1,2,3,
Silvia Sartorelli
1,2,3,
Elisabetta Falbo
2,3,
Raffaella Scotti
3,
Gaetano Di Terlizzi
3,
Lorenzo Dagna
1,2,
Luisa Praderio
3,
Maria Grazia Sabbadini
2,3,
Enrica P. Bozzolo
3 and
Moreno Tresoldi
3
1
Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
2
Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
3
Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2024, 14(1), 115; https://doi.org/10.3390/jpm14010115
Submission received: 20 December 2023 / Revised: 14 January 2024 / Accepted: 19 January 2024 / Published: 20 January 2024
(This article belongs to the Section Epidemiology)
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Abstract

Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.
Keywords: sustainability; general internal medicine; healthcare resources; hospital-acquired infections; length of stay; in-hospital mortality sustainability; general internal medicine; healthcare resources; hospital-acquired infections; length of stay; in-hospital mortality

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MDPI and ACS Style

Ramirez, G.A.; Damanti, S.; Caruso, P.F.; Mette, F.; Pagliula, G.; Cariddi, A.; Sartorelli, S.; Falbo, E.; Scotti, R.; Di Terlizzi, G.; et al. Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. J. Pers. Med. 2024, 14, 115. https://doi.org/10.3390/jpm14010115

AMA Style

Ramirez GA, Damanti S, Caruso PF, Mette F, Pagliula G, Cariddi A, Sartorelli S, Falbo E, Scotti R, Di Terlizzi G, et al. Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. Journal of Personalized Medicine. 2024; 14(1):115. https://doi.org/10.3390/jpm14010115

Chicago/Turabian Style

Ramirez, Giuseppe A., Sarah Damanti, Pier Francesco Caruso, Francesca Mette, Gaia Pagliula, Adriana Cariddi, Silvia Sartorelli, Elisabetta Falbo, Raffaella Scotti, Gaetano Di Terlizzi, and et al. 2024. "Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study" Journal of Personalized Medicine 14, no. 1: 115. https://doi.org/10.3390/jpm14010115

APA Style

Ramirez, G. A., Damanti, S., Caruso, P. F., Mette, F., Pagliula, G., Cariddi, A., Sartorelli, S., Falbo, E., Scotti, R., Di Terlizzi, G., Dagna, L., Praderio, L., Sabbadini, M. G., Bozzolo, E. P., & Tresoldi, M. (2024). Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. Journal of Personalized Medicine, 14(1), 115. https://doi.org/10.3390/jpm14010115

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