Akutte indlæggelser på de intern medicinske afdelinger i Danmark Betina Vest Hansen, Klinisk Epidemiologisk Afd., Aarhus Universitetshospital

PhD-Projekt Initieret i 2010 Populations-baserede studier med nationale data på akutte medicinske patienter indlagt på interne medicinske afdelinger i 2010 Data er indhentet fra Landspatientregistret.

Hvorfor intern medicin? Historisk set fokus på enkeltsygdomme, f.eks. AMI, Slagtilfælde Stigende subspecialisering Aldrende befolkning Stigende andel af befolkningen der lever med kroniske sygdomme

Hvorfor akutte indlæggelser? Stigende antal Omstrukturering af modtagelsen af akutte patienter Akut indlæggelse kan være Primær sygdom Akut forværring af kronisk sygdom Komplikation til kronisk sygdom

Akut hospitalsbehandling i Danmark WHO´s definition af akut behandling “a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization” Henvisende instanser Praktiserende læger Skadestuer Privat praktiserende speciallæger

Landspatientregistret Vigtige variable Afd. Kode (OBS Specialekode), indlæggelsesmåde, kontakter forud, diagnoser på kroniske sygdomme forud for indlæggelsen (Charlson Comorbiditets Index), primær diagnose Validitet af anvendte variable Indlæggelsesmåden

Studiepopulationen All admissions in 2010 3,969,315 All acute admissions in 2010 2,842,614 All Acute admissions to departments of internal medicine in 2010 1,028,645 Any admission to a medical department after first admission in 2010 758,906 Exclusions (visitors, CPR-numbers without follow up, children<15 years 5,474 First acute admission to a medical department in 2010 264,265

Patient Characteristics Gender n % Male 128,808 48.7 Age group, Years 15-39 43,864 16.6 40-59 66,043 25.0 60-79 100,016 37.9 80+ 54,342 20.5 Charlson Comorbidity Index Low (0) 145,156 54.9 Moderate (1-2) 83,987 31.8 High (3+) 35,122 13.3 Source of admission Hospital departments 81,130 (30.7) Outpatient clinics 14,172 (5.4) Emergency rooms 64,397 (24.4) Direct (e.g., referred from a GP) 132,119 (50.0)

Patient Characteristics Gender n % Male 128,808 48.7 Age group, Years 15-39 43,864 16.6 40-59 66,043 25.0 60-79 100,016 37.9 80+ 54,342 20.5 Charlson Comorbidity Index Low (0) 145,156 54.9 Moderate (1-2) 83,987 31.8 High (3+) 35,122 13.3 Source of admission Hospital departments 81,130 (30.7) Outpatient clinics 14,172 (5.4) Emergency rooms 64,397 (24.4) Direct (e.g., referred from a GP) 132,119 (50.0)

Patient Characteristics Gender n % Male 128,808 48.7 Age group, Years 15-39 43,864 16.6 40-59 66,043 25.0 60-79 100,016 37.9 80+ 54,342 20.5 Charlson Comorbidity Index Low (0) 145,156 54.9 Moderate (1-2) 83,987 31.8 High (3+) 35,122 13.3 Source of admission Hospital departments 81,130 (30.7) Outpatient clinics 14,172 (5.4) Emergency rooms 64,397 (24.4) Direct (e.g., referred from a GP) 132,119 (50.0)

Patient Characteristics Gender n % Male 128,808 48.7 Age group, Years 15-39 43,864 16.6 40-59 66,043 25.0 60-79 100,016 37.9 80+ 54,342 20.5 Charlson Comorbidity Index Low (0) 145,156 54.9 Moderate (1-2) 83,987 31.8 High (3+) 35,122 13.3 Source of admission Hospital departments 81,130 (30.7) Outpatient clinics 14,172 (5.4) Emergency rooms 64,397 (24.4) Direct (e.g., referred from a GP) 132,119 (50.0)

Primary diagnoses n=264,265 n % Infections incl. pneumonia 40,865 15.5 Neoplasm 3,483 1.3 Haematological disorders 5,214 2.0 Endocrine/metabolic disorders 12,925 4.9 Mental disorders 7,755 2.9 Neurological disorders 11,192 4.2 Cardiovascular disorders 51,056 19.3 Respiratory disorders 12,719 4.8 Digestive disorders 10,186 3.9 Musculoskeletal disorders 9,560 3.6 Genitourinary disorders 3,886 1.5 Injury/poisoning 16,508 6.3 Ill-defined signs or symptoms (R-chapter or Z-chapter) 75770 28.7 Other (ear, eye, and skin diseases) 3,146 1.2

Charlson Comorbidity Index Primary diagnoses Charlson Comorbidity Index Low Moderate High Infection 19,289 (47.2) 14,644 (35.8) 6,932 (17.0) Neoplasm 1,118 (32.1) 1,361 (39.1) 1,004 (28.8) Haematological disorders 2,044 (39.2) 1,994 (38.2) 1,176 (22.6) Endocrine/metabolic disorders 4,845 (37.5) 5,282 (40.9) 2,798 (21.7) Mental disorders 5,325 (68.7) 1,899 (24.5) 531 (6.9) Neurological disorders 7,325 (65.5) 2,980 (26.6) 887 (7.9) Cardiovascular disorders 27,347 (53.6) 17,317 (33.9) 6,392 (12.5) Respiratory disorders 3,552 (27.9) 6,616 (52.1) 2,551 (20.1) Digestive disorders 5,553 (54.6) 2,982 (29.4) 1,651 (16.2) Musculoskeletal disorders 6,262 (65.5) 2,481 (26.0) 817 (8.6) Genitourinary disorders 1,311 (33.7) 1,236 (31.8) 1,339 (34.6) Injury/poisoning 12,270 (74.3) 3,212 (19.6) 1,026 (6.2) Ill-defined signs or symptoms (R-chapter or Z-chapter) 46,576 (61.5) 12,980 (28.2) 7,824 (10.3) Other (Ear, eye, and skin) 2,339 (74.4) 613 (19.5) 194 (6.2)

Standardized* 30-days mortality rate Primary diagnoses Crude n (%) Standardized (95% CI) Infection 3133 (7.7) 6.6 (6.4-6.9) Neoplasm 595 (17.1) 14.1 (12.9-15.3) Haematological disorders 274 (5.2) 3.9 (3.4-4.5) Endocrine/metabolic disorders 869 (6.7) 5.0 (4.6-5.3) Mental disorders 161 (2.1) 3.4 (2.9-4.0) Neurological disorders 218 (1.9) 2.6 (2.2-2.9) Cardiovascular disorders 3266 (6.4) 5.8 (5.6-6.0) Respiratory disorders 1393 (11.0) 9.5 (9.0-10.0) Digestive disorders 667 (6.5) 6.8 (6.3-7.3) Musculoskeletal disorders 106 (1.1) 1.4 (1.1-1.7) Genitourinary disorders 284 (7.3) 5.6 (4.9-6.3) Injury/poisoning 298 (1.8) 3.1 (2.8-3.5) Ill-defined signs or symptoms (R-chapter or Z-chapter) 2595 (3.5) 4.1 (3.9-4.3) Other (Ear, eye, and skin) 27 (0.9) 1.6 (0.9-2.1)

Standardized* 30-days mortality rate Primary diagnoses Crude n (%) Standardized (95% CI) Infection 3133 (7.7) 6.6 (6.4-6.9) Neoplasm 595 (17.1) 14.1 (12.9-15.3) Haematological disorders 274 (5.2) 3.9 (3.4-4.5) Endocrine/metabolic disorders 869 (6.7) 5.0 (4.6-5.3) Mental disorders 161 (2.1) 3.4 (2.9-4.0) Neurological disorders 218 (1.9) 2.6 (2.2-2.9) Cardiovascular disorders 3266 (6.4) 5.8 (5.6-6.0) Respiratory disorders 1393 (11.0) 9.5 (9.0-10.0) Digestive disorders 667 (6.5) 6.8 (6.3-7.3) Musculoskeletal disorders 106 (1.1) 1.4 (1.1-1.7) Genitourinary disorders 284 (7.3) 5.6 (4.9-6.3) Injury/poisoning 298 (1.8) 3.1 (2.8-3.5) Ill-defined signs or symptoms (R-chapter or Z-chapter) 2595 (3.5) 4.1 (3.9-4.3) Other (Ear, eye, and skin) 27 (0.9) 1.6 (0.9-2.1)

Standardized* 30-days mortality rate Primary diagnoses Crude n (%) Standardized (95% CI) Infection 3133 (7.7) 6.6 (6.4-6.9) Neoplasm 595 (17.1) 14.1 (12.9-15.3) Haematological disorders 274 (5.2) 3.9 (3.4-4.5) Endocrine/metabolic disorders 869 (6.7) 5.0 (4.6-5.3) Mental disorders 161 (2.1) 3.4 (2.9-4.0) Neurological disorders 218 (1.9) 2.6 (2.2-2.9) Cardiovascular disorders 3266 (6.4) 5.8 (5.6-6.0) Respiratory disorders 1393 (11.0) 9.5 (9.0-10.0) Digestive disorders 667 (6.5) 6.8 (6.3-7.3) Musculoskeletal disorders 106 (1.1) 1.4 (1.1-1.7) Genitourinary disorders 284 (7.3) 5.6 (4.9-6.3) Injury/poisoning 298 (1.8) 3.1 (2.8-3.5) Ill-defined signs or symptoms (R-chapter or Z-chapter) 2595 (3.5) 4.1 (3.9-4.3) Other (Ear, eye, and skin) 27 (0.9) 1.6 (0.9-2.1)

Length of hospital stay Days (IQR) Age group, years 15 – 39 1 (0.5-2) 40 – 59 1 (1-4) 60 – 79 3 (1-7) 80+ 5 (1-10) CCI-score   Low (0) Moderate (1-2) High (3+) 4 (1-9) Source of admission* Non-medical hospital departments 0.5 (0.5-3) Outpatient clinics 2 (1-7) Emergency rooms 1 (1-5) Direct (e.g. from general practitioner)

Length of hospital stay Primary diagnoses Length of hospital stay Days (IQR) Infection 4 (2-8) Neoplasm 7 (2-15) Haematological disorders 2 (1-6) Endocrine/metabolic disorders 3 (1-8) Mental disorders 1 (0.5-2) Neurological disorders 1 (1-4) Cardiovascular disorders 3 (1-7) Respiratory disorders Digestive disorders Musculoskeletal disorders 2 (0.5-6) Genitourinary disorders 4 (1-9) Injury/poisoning Ill-defined signs or symptoms (R-chapter or Z-chapter) 1 (0.5-4) Other (Ear, eye, and skin) 1 (0.5-3)

Length of hospital stay Primary diagnoses Length of hospital stay Days (IQR) Infection 4 (2-8) Neoplasm 7 (2-15) Haematological disorders 2 (1-6) Endocrine/metabolic disorders 3 (1-8) Mental disorders 1 (0.5-2) Neurological disorders 1 (1-4) Cardiovascular disorders 3 (1-7) Respiratory disorders Digestive disorders Musculoskeletal disorders 2 (0.5-6) Genitourinary disorders 4 (1-9) Injury/poisoning Ill-defined signs or symptoms (R-chapter or Z-chapter) 1 (0.5-4) Other (Ear, eye, and skin) 1 (0.5-3)

Udfordringer Litteratur Heterogen population Registerbaseret studie Sværhedsgrad af sygdom Kliniske forløb

Perspektiver Uspecifikke diagnoser Akut hospitalsbehandling Hvor mange? Hvem? Hvorfor? Akut hospitalsbehandling Organisering? Multimorbiditet?

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