title: [Incidence and clinical features of patients with comorbidity attended in internal medicine areas].
abstract: OBJECTIVE
  Our objective was to assess the incidence and clinical features of patients with numerous disorders--comorbidity patients (CP)--and to clinically validate the CP criteria defined by a panel of experts (patients with 2 or more chronic diseases, distributed into seven categories).
  
  
  METHODS
  Prospective observational study of all patients, attended in internal medicine areas of a tertiary teaching hospital, during June 2003. Patients were stratified in 3 cohorts: CP, palliative, and general (GE). Incidence of CP, functional evaluation (at baseline, at admission, and at discharge), and burden of hospital care (by means of urgent and programmed visits, as well as episodes of hospitalization) in the last 12 months were analyzed. A multivariate analysis of predictors of survival and functional deterioration (fall in Barthel's scale > or = 10 points between baseline-discharge values) was performed in the CP cohort.
  
  
  RESULTS
  339 patients (CP cohort: 132; palliative: 52; GE: 155) were included. The overall incidence was 38.9/100 admissions/month. CP were older (75 [11] vs 67 [16]); had higher mortality (19.3% vs 6.1%; relative risk [RR]: 3.66 [95% confidence interval [CI], 1.65-8.13]; lower functional ability at baseline (45 vs 95), at admission (20 vs 75), and at discharge (20 vs 95); higher rates of significant functional deterioration (16% vs 7%; RR = 2.47 [95% CI, 1.15-5.35]); and required more burden of hospital care by means of urgent care (3.6 [3.4] episodes vs 2.4 [1.9]), and hospitalizations (1.9 [1.3] vs 1.5 [1]) than GE patients. Chronic digestive/hepatic diseases (odds ratio [OR] = 48.3 [2.4-980.9], peripheric vascular disease/diabetes with visceral involvement (OR = 5.6 [CI 95%, 1.1-28.6]), and better functional ability at admission were associated with survival. Female gender (OR ) 46.6 [CI 95%, 4.5-486.9]), chronic lung disease (OR = 8.9 [CI 95%, 1.2-64]), and neurologic disease with disability (OR = 8 [CI 95%, 1.1-58.9]), were associated with significant functional deterioration during hospital stay.
  
  
  CONCLUSIONS
  The defined CP criteria were highly accurate in detecting a population of patients with high attention in Internal Medicine areas, high mortality rates, clinical frailty (more need of hospital care), and significant functional deterioration. Barthel's scale identified correctly this group of patients, and was independently associated with survival.
authors.affiliation: Unidad Clínica de Atención Médica Integral, Servicio de Medicina Interna, Hospitales Universitarios Virgen del Rocío, 41013 Sevilla, España. salvaymar@vodafone.es
authors.forename: José Salvador
authors.initials: JS
authors.lastname: García-Morillo
authors.forename: Máximo
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.forename: Manuel
authors.initials: M
authors.lastname: Ollero-Baturone
authors.forename: Manuela
authors.initials: M
authors.lastname: Aguilar-Guisad
authors.forename: Nieves
authors.initials: N
authors.lastname: Ramírez-Duque
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: González de la Puente
authors.forename: Pilar
authors.initials: P
authors.lastname: Limpo
authors.forename: Susana
authors.initials: S
authors.lastname: Romero-Carmona
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Cuello-Contreras
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies