Researchers Identify Costly Inpatient Medical Services

The most commonly reported and most costly conditions treated by general internal medicine inpatient services were recently identified in a new study published online in the Journal of General Internal Medicine.

In order to implement quality improvement, develop health policy, conduct research, and design medical education, a research team led by Amol Verma, a Phillipson Scholar in the University of Toronto Department of Medicine Clinician-Scientist Training Program and an Interdisciplinary Fellow with the Canadian Frailty Network, and colleagues sought to identify the most common and costly conditions treated by inpatient general medical services. The researchers conducted a retrospective cross-sectional study that examined 7 hospital sites.

The researchers used hospital administrative data to identify diagnoses and costs associated with admissions. They identified patients discharged between April 1, 2010 and March 31, 2015 who were admitted to or discharged from an inpatient general internal medicine service. Finally, the researchers used each admission to define the primary discharge diagnosis, then categorized that into clinically relevant and mutually exclusive categories using the Clinical Classifications Software (CCS) tool.

According to the findings of the study, among 148,442 admissions, 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%), and the prevalence of the 20 most common conditions was significantly correlated across hospitals. The researchers found that no single condition represented more than 5.1% of all admissions or more than 7.9% of admissions at any hospital site. Notably, the costliest conditions were stroke (total cost $94,199,422, representing 6.0% of all costs) and the group of delirium, dementia, and cognitive disorders (total cost $77,372,541, representing 4.9% of all costs).

“The 10 most common conditions accounted for only 36.2% of hospitalizations and 36.8% of total costs,” the researchers explained. “The remaining hospitalizations included 223 different CCS conditions.”

The researchers noted that based on their findings, the diversity of conditions cared for in general inpatient medicine may be challenging for health care 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 [general internal medicine] population than disease-specific efforts,” the researchers concluded.

—Julie Gould

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