title: Quick diagnosis units or conventional hospitalisation for the diagnostic evaluation of severe anaemia: a paradigm shift in public health systems?
abstract: BACKGROUND
  Acute hospital bed utilisation is a growing concern for health care systems in most countries with public health models, as it represents a significant share of health costs. Anaemia with haemoglobin levels below 8 g/l has traditionally been a criterion used to hospitalise patients in our centre for diagnosis.
  
  
  METHODS
  We conducted a longitudinal study with a prospective and retrospective cohort to investigate the usefulness of a Quick Diagnosis Unit (QDU) for the evaluation of patients with severe anaemia as compared with hospitalisation in a tertiary public hospital. We recorded pretransfusion haemoglobin and haematocrit values, Charlson comorbidity index, waiting time for the first visit, time to diagnosis (length-of-stay in hospitalised patients), final diagnosis, costs, and responses to an opinion survey.
  
  
  RESULTS
  QDU patients were significantly younger [65.63 years (17.44)] than hospitalised patients [76.11 years (12.68)] (P<.0001). No significant differences were observed regarding time to diagnosis/length-of-stay, haemoglobin concentrations and Charlson index. Iron-deficiency anaemia was the commonest type of anaemia in both cohorts and benign digestive lesions accounted for most cases. The mean cost per process (admission-discharge episode) was 2920.62 Euros in the QDU and 18,278.01 Euros in hospitalised patients. If further diagnostic tests were required, 85% of patients would prefer the QDU care model to conventional hospital admission.
  
  
  CONCLUSIONS
  For diagnostic purposes, patients with severe anaemia can be managed similarly in a QDU or in-hospital setting, but the QDU model is more cost-saving than traditional hospitalisation. Most QDU patients preferred the QDU model to hospital admission.
authors.affiliation: Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain. xavbosch@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Frank
authors.initials: F
authors.lastname: Palacios
authors.forename: Gabriel
authors.initials: G
authors.lastname: Inclán-Iríbar
authors.forename: Marta
authors.initials: M
authors.lastname: Castañeda
authors.forename: Anna
authors.initials: A
authors.lastname: Jordán
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: Antonio
authors.initials: A
authors.lastname: Coca
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Soto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011634:Public Health; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain