The influence of nursing homes in the functioning of internal medicine services

Some hospitals attend to great number of patients who come from nursing homes whose median age, seriousness of illness and comorbidity differ of these patients from those of non-institutionalized patients. This can partly modify and thereby affect some of the parameters used to measure "assistance quality".

The data related to the demographic, clinical factors, severity criteria and mortality, were studied in patients hospitalized in two Internal Medicine Services during 2005-6 on the basis of whether they arrived from a nursing home or not. The data were obtained from the electronic databases of the two centers.

During the study period, 13,712 patients were hospitalized (7110 in Fundación Hospital Alcorcón (FHA) and 6602 in Hospital Universitario Fuenlabrada (HUF)). A total of 789 (15.3%) patients of FHA arrived from a nursing home in comparison to 132 (2.6%) of those in HUF. Patients arriving from nursing homes were older (84.1 vs 69.8; p<0.05), had a more serious illness (Group Related Diagnostic weight 2.1 vs 1.9; p<0.05), more comorbidity (Charlson Index >0; 75.5% vs 67.3%; p<0.05) and increased mortality (16.8% vs 6.8%; p<0.05) than the non-institutionalized patients, while length of hospital stay were shorter in the institutionalized patients (7.8 vs 8.3; p<0.05). Intrahospital mortality was significantly associated with living in a nursing home (Odds Ratio 1.4 Confidence Interval 95% 1.1-1.8), regardless of age, gender, condition, comorbidity (Charlson Index), and the involved hospital.

The number of nursing homes attended by a hospital determined the activity of an Internal Medicine Service. This study indicates that the patients from nursing homes were older, with increased severity and comorbidity of their illness, greater mortality and rehospitalization although, with similar length of stay.