Analysis of the impact of sub-acute care activities on consumption of hospital resources in Milan

Abstract

Abstract Background In 2011, a new health service called 'sub-acute care activities' (SA) has been provided by Lombardy. It is a protected hospitalization of patients, especially elderlies, suffering for clinical issues following an acute disease or for non-complex clinical failures due to a chronic pathology. This is a hospitalization area between the hospital and home, created to reduce the number of post-acute hospitalized patients who can't be discharged. The goal of this study is the analysis of the hospitalizations in the SA setting within medical structures located in the Metropolitan area of Milan. Methods The data extracted from the hospital discharge card database, is focused on hospitalizations in SA that occurred from 2016 to 2019. The analysis describes yearly production, the characteristics of hospitalizations and patients, finally some trends. Results 16,395 hospitalizations in SA were analyzed (0.7% of the total). Some data are constant in time: hospitalizations (1%), age (average 79), days of hospitalization (average 26). Patients coming from public hospitals (from 28% to 22%) are decreasing while those coming from other in-patient admission typologies within the same organization (from 44% to 54%) are increasing. The major diagnostic categories are related to cardiovascular and respiratory diseases. Over the 85% of hospitalizations are paid with the highest daily rate among those allowed by law. Talking about discharge typologies, 57% of patients return home, 20% are re-transferred to the acute ward, 16% are sent to rehabilitation/long-term care while 7% have died. Conclusions The use of the highest daily tariff and the high number of patients who need to be re-transferred to the acute ward place, gives many doubts on how appropriate is allocation of resources and about the accuracy of admissions in the SA unit during the patient care path. We're planning to return to these issues with further targeted studies. Key messages The analysis showed constant characteristics of SA activities during the four years. Data showed that there may be management issues in the appropriate use of resources in SA assistence.