title: [Profile and evolution of chronic complex patients in a subacute unit].
abstract: OBJECTIVE
  To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated.
  
  
  METHODS
  Descriptive-comparative, cross-sectional, and quantitative study.
  
  
  METHODS
  SG located in intermediate care hospital.
  
  
  METHODS
  Consecutive patients admitted in the SG during 6months.
  
  
  METHODS
  We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30days post-discharge between PCC/MACA patients versus other patients.
  
  
  RESULTS
  Of 244 patients (mean age±SD=85,6±7,5; 65.6%women), 91 (37,3%) were PCC/MACA (PCC=79,1%, MACA=20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index=3,2±1,8 vs 2,0; p=0,001) and polypharmacy (9,5±3,7 drugs vs 8,1±3,8; p=0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30day post-discharge (15,4% vs 8%; p=0,010). In a multi-variable analysis, PCC/MACA identification (p=0,006), as well as a history of dementia (p=0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30day (18,7% vs 10,5%; p=0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission.
  
  
  CONCLUSIONS
  Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30days, possibly due to comorbidity and polypharmacy.
authors.affiliation: Hospital d'Atenció Intermèdia Parc Sanitari Pere Virgili, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: ngual@perevirgili.cat.
authors.forename: Neus
authors.initials: N
authors.lastname: Gual
authors.affiliation: Hospital d'Atenció Intermèdia Parc Sanitari Pere Virgili, Barcelona, España.
authors.forename: Anna
authors.initials: A
authors.lastname: Yuste Font
authors.affiliation: Àmbit d'Atenció Primària, Institut Català de la Salut, Barcelona, España.
authors.forename: Belen
authors.initials: B
authors.lastname: Enfedaque Montes
authors.affiliation: Pla de Prevenció i Atenció a la Cronicitat, Departament de Salut, Generalitat de Catalunya, Barcelona, España.
authors.forename: Carles
authors.initials: C
authors.lastname: Blay Pueyo
authors.affiliation: Equip d'Atenció Primària Vallcarca-Sant Gervasi, Barcelona, España.
authors.forename: Remedios
authors.initials: R
authors.lastname: Martín Álvarez
authors.affiliation: Hospital d'Atenció Intermèdia Parc Sanitari Pere Virgili, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D000071069:Multiple Chronic Conditions / Q000628:therapy*; D011446:Prospective Studies; D019467:Subacute Care; D016896:Treatment Outcome
keywords: Atención intermedia; Chronicity; Cronicidad; Intermediate care; Mortalidad; Mortality; Multimorbidity; Multimorbilidad; Readmissions; Reingresos; Subacute care unit; Subagudos