title: Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.
abstract: OBJECTIVE
  Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT.
  
  
  METHODS
  This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS.
  
  
  RESULTS
  There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893.
  
  
  CONCLUSIONS
  Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España. Electronic address: eduardo.montero@salud.madrid.org.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montero Ruiz
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Rebollar Merino
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rivera Rodríguez
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: Marta
authors.initials: M
authors.lastname: García Sánchez
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Agudo Alonso
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Barbero Allende
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006748:Hospital Departments / Q000458:organization & administration*; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D038801:International Classification of Diseases; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000458:organization & administration*; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D055815:Young Adult
keywords: Asistencia compartida; Co-management; Internal medicine; Medicina Interna; Otolaryngology; Otorrinolaringología; Referral and consultation; Remisión y consulta