title: Admission of nursing home residents to a hospital internal medicine department.
abstract: OBJECTIVE
  Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm.
  
  
  METHODS
  In this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs.
  
  
  RESULTS
  Between January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02-1.03), female gender (OR 1.13, 95% CI 1.13-1.17), dementia (OR 1.09, 95% CI 1.03-1.16), previous feeding tube (OR 1.34, 95% CI 1.09-1.79), malignant disease (OR 2.03, 95% CI 1.86-2.23), acute infectious disease (OR 1.18, 95% CI 1.12-1.25), pressure sores (OR 1.88, 95% CI 1.62-1.95), acute respiratory failure (OR 2.00, 95% CI 1.90-2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23-2.72).
  
  
  CONCLUSIONS
  Two of every 100 patients admitted to internal medicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life.
authors: Internal Medicine, Hospital Infanta Cristina, Madrid, Spain. raquel.barba@salud.madrid.org
authors: Raquel
authors: R
authors: Barba
authors: Antonio
authors: A
authors: Zapatero
authors: Javier
authors: J
authors: Marco
authors: Alejandro
authors: A
authors: Perez
authors: Jesús
authors: J
authors: Canora
authors: Susana
authors: S
authors: Plaza
authors: Juan
authors: J
authors: Losa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007388:Internal Medicine; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission / Q000639:trends*; D010360:Patient Transfer; D013030:Spain