[Profile and evolution of chronic complex patients in a subacute unit]

Area of Science:

• Geriatric Medicine
• Internal Medicine
• Health Services Research

Background:

• Geriatric pluripathologic patients require specialized management.
• Subacute geriatric units (SG) are an alternative to acute hospitals for patients with exacerbated chronic diseases.
• The outcomes of identified chronic complex patients (PCC) or patients with advanced chronic disease (MACA) in SGs are not well-evaluated.

Purpose of the Study:

• To evaluate the care process outcomes for patients identified as PCC/MACA admitted to subacute geriatric units (SG).
• To compare baseline characteristics, discharge results, and 30-day post-discharge outcomes between PCC/MACA patients and other patients in SGs.

Main Methods:

• A descriptive-comparative, cross-sectional, quantitative study was conducted.
• Consecutive patients admitted to SGs in intermediate care hospitals over 6 months were included.
• Baseline demographics, clinical data, geriatric assessments, discharge outcomes, and 30-day post-discharge data were compared between PCC/MACA and other patients.

Main Results:

• Of 244 patients, 91 (37.3%) were identified as PCC/MACA, exhibiting greater comorbidity and polypharmacy compared to unidentified patients.
• At discharge, return to residence and mortality were comparable; however, PCC/MACA patients had higher 30-day mortality (15.4% vs 8%).
• PCC/MACA identification and dementia history were associated with mortality, while higher 30-day readmission rates (18.7% vs 10.5%) were linked to male sex, polypharmacy, and heart failure.

Conclusions:

• Patients identified as PCC/MACA in SGs had comparable outcomes at discharge despite higher comorbidity and polypharmacy.
• These patients experienced increased 30-day readmissions, potentially due to their complex health profiles.
• The findings suggest a need for tailored management strategies for PCC/MACA patients in subacute geriatric settings.