[Internal medicine: A core discipline in healthcare establishments for the care of complex patients]

Abstract

Introduction: The role of internal medicine departments in the management of chronic diseases in older patients with more comorbidities is a topical issue.

Methods: For each internal medicine department of the Lyon University Hospital (North, Centre and South Hospices Civils de Lyon Hospital Group), Programme de médicalisation des systèmes d'information (PMSI) activity report data were used, with the number of medical unit summary (RUM) and standardised discharge summary (RSS) stays for 4 consecutive years from 2018 to 2022.

Results: Activity increased in the three internal medicine departments in outpatient day hospital activity, the rest of the activity remained stable. The rate of admissions via emergency units was multiplied by 3, with an increase in discharges to rehabilitation services. The death rate doubled. The average age increased to 68, with an increase in the Charlson score comorbidity index to 2, independently of age, and in the percentage of stays with severity 3 and 4.

Conclusion: Analysis of data on conventional inpatient care in internal medicine at Lyon University Hospital shows a major qualitative change, with older patients with more comorbidities and higher severity stay profiles, leading to an increase in the number of inpatient deaths, and greater use of rehabilitation units.

Keywords: Activité de soins; Charlson's score; Comorbidities; Comorbidités; Healthcare activity; Internal medicine; Médecine interne; Score de Charlson.