Inpatient medicine services see wide variety of conditions in similar pattern across hospitals

At seven hospitals in Toronto, the most common primary discharge diagnoses were heart failure, pneumonia, urinary tract infection, chronic obstructive pulmonary disease, and stroke.

The most common discharge diagnoses are similar across general internal medicine (GIM) services at different hospitals, a recent study found.

The retrospective cross-sectional study included all patients admitted to an inpatient GIM service at any of seven hospitals in Toronto, Canada, and discharged between April 1, 2010, and March 31, 2015. Hospital administrative data were used to identify diagnoses (which were categorized using the Clinical Classifications Software tool) and costs associated with the 148,442 admissions. Results were published by the Journal of General Internal Medicine on July 27.

The most common primary discharge diagnoses were heart failure (5.1%), pneumonia (5.0%), urinary tract infection (4.6%), chronic obstructive pulmonary disease (4.5%), and stroke (4.4%). Looking at the 20 most common conditions, the researchers found a significant correlation across hospitals, with at least 15 of them being among the top 20 at each hospital. No single condition was responsible for more than 5.1% of overall admissions or more than 7.9% of any individual hospital's admissions. The highest-cost conditions were stroke (median cost, $7,122; interquartile range [IQR], $5,587 to $12,354; total cost, $94,199,422; 6.0% of all costs) and the grouping of delirium, dementia, and cognitive disorders (median cost, $12,831; IQR, $9,539 to $17,509; total cost, $77,372,541; 4.9% of all costs).

The 10 most common conditions accounted for 36.2% of hospitalizations, which is much lower than the 83.3% and 72.6% that other studies have found for emergency general surgery and emergency ICU admissions, respectively, the authors said. Other than those 10, the discharge diagnoses represented 223 different condition categories in the Clinical Classifications Software, the authors noted.

“The diversity of conditions cared for in GIM may be challenging for healthcare delivery and quality improvement. Initiatives that cut across individual diseases to address processes of care, patient experience, and functional outcomes may be more relevant to a greater proportion of the GIM population than disease-specific efforts,” they said.

However, disease-specific approaches will continue to also be important to improving health care, and the study's findings about the mostly common and costly conditions could inform these approaches, the authors added. The study was limited by its relatively small sample and use of ICD-10 codes. The findings are also not necessarily generalizable to smaller nonteaching hospitals, they said.