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Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1899–1904 | Cite as

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

  • Amol A. Verma
  • Yishan Guo
  • Janice L. Kwan
  • Lauren Lapointe-Shaw
  • Shail Rawal
  • Terence Tang
  • Adina Weinerman
  • Fahad Razak
Original Research

Abstract

Background

Understanding the most common and costly conditions treated by inpatient general medical services is important for implementing quality improvement, developing health policy, conducting research, and designing medical education.

Objective

To determine the prevalence and cost of conditions treated on general internal medicine (GIM) inpatient services.

Design

Retrospective cross-sectional study involving 7 hospital sites in Toronto, Canada.

Participants

All patients discharged between April 1, 2010 and March 31, 2015 who were admitted to or discharged from an inpatient GIM service.

Main Measures

Hospital administrative data were used to identify diagnoses and costs associated with admissions. The primary discharge diagnosis was identified for each admission and categorized into clinically relevant and mutually exclusive categories using the Clinical Classifications Software (CCS) tool.

Key Results

Among 148,442 admissions, the most common primary discharge diagnoses were heart failure (5.1%), pneumonia (5.0%), urinary tract infection (4.6%), chronic obstructive pulmonary disease (4.5%), and stroke (4.4%). The prevalence of the 20 most common conditions was significantly correlated across hospitals (correlation coefficients ranging from 0.55 to 0.95, p ≤ 0.01 for all comparisons). No single condition represented more than 5.1% of all admissions or more than 7.9% of admissions at any hospital site. The costliest conditions were stroke (median cost $7122, interquartile range 5587–12,354, total cost $94,199,422, representing 6.0% of all costs) and the group of delirium, dementia, and cognitive disorders (median cost $12,831, IQR 9539–17,509, total cost $77,372,541, representing 4.9% of all costs). The 10 most common conditions accounted for only 36.2% of hospitalizations and 36.8% of total costs. The remaining hospitalizations included 223 different CCS conditions.

Conclusions

GIM services care for a markedly heterogeneous population but the most common conditions were similar across 7 hospitals. The diversity of conditions cared for in GIM may be challenging for healthcare delivery and quality improvement. Initiatives that cut across individual diseases to address processes of care, patient experience, and functional outcomes may be more relevant to a greater proportion of the GIM population than disease-specific efforts.

KEY WORDS

internal medicine diagnoses hospitalist health services research cost 

Notes

Funders

GEMINI was supported by grants from Green Shield Canada Foundation and the University of Toronto Division of General Internal Medicine.

Compliance with ethical standards

Research ethics board approval was obtained from all participating hospitals.

Prior presentations

Some of the findings included in this manuscript were presented as a poster at the Canadian Frailty Network 2017 National Conference, April 23, 2017 in Toronto, Canada..

Conflict of interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4591_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)
11606_2018_4591_MOESM2_ESM.xlsx (41 kb)
ESM 2 (XLSX 41 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Amol A. Verma
    • 1
    • 2
  • Yishan Guo
    • 1
  • Janice L. Kwan
    • 2
    • 3
  • Lauren Lapointe-Shaw
    • 2
  • Shail Rawal
    • 2
    • 4
  • Terence Tang
    • 2
    • 5
  • Adina Weinerman
    • 2
    • 6
  • Fahad Razak
    • 1
    • 2
    • 7
    • 8
  1. 1.Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  2. 2.Department of MedicineUniversity of TorontoTorontoCanada
  3. 3.Department of MedicineMount Sinai HospitalTorontoCanada
  4. 4.Division of General Internal MedicineUniversity Health NetworkTorontoCanada
  5. 5.Institute for Better HealthTrillium Health PartnersTorontoCanada
  6. 6.Sunnybrook Health Sciences CentreTorontoCanada
  7. 7.Harvard Center for Population and Development StudiesCambridgeUSA
  8. 8.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada

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