An Infectious Disease Day-Hospital service in a metropolitan area of Northern Italy. Evolving assistance features in the last fifteen years (1994-2008)
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KeywordsHealth Care Provision Occupation Rate Funding Resource Infectious Disorder Assistential Planning
Aim of our study is to evaluate the frequency and features of admissions performed at an Infectious Diseases Day-Hospital service at S. Orsola Hospital, Bologna, Italy.
A retrospective evaluation of all admissions of the last 15 years (1994-2008), was performed.
Before the introduction of potent, combination antiretroviral treatments (cART) (years 1994-1996), the proportionally low mean number of admissions (110/year), was linked to the elevated prevalence of HIV disease, which accounted for 89.4% of Day-Hospital hospitalizations, their recurrence, and their prolonged duration. Immediately after cART introduction, the number of Day-Hospital admissions showed a significant increase, from 171 (year 1997), to 318 (2002),338 (2003),347 (2004),331 (2005),356 (2006), 341 (2007), and 378 (2008) (p < .0001 versus the pre-cART era), although this phenomenon paralleled a drop of percentage of HIV-related admissions (from 59.1% of 1997, to a minimum of 23.8% of the year 2005; p < .0001). While HIV-associated hospitalizations decreased, a temporal increase of admissions due to chronic liver disease occurred (p < .0001). The reduction of admission duration allowed an increase of overall number of hospitalizations of each examined year (p < .0001), and the mean bed occupation rate showed a continued rise (8.2 in the year 2000, to maximum value of 12.0 reached in the year 2006 (p < .0001).
The modifications occurred at our Infectious Diseases Day-Hospital service during the last 15 years are largely attributable to the significant changes occurred in the spectrum of infectious disorders which came to our attention: from a low number of prolonged hospitalizations typical of patients with advanced HIV disease, the cART era led to a progressive broadening of the spectrum of disease, and a notable reduction of admission time. Notwithstanding this situation, no significant modification was observed as to mean weight of diagnosis-related group (DRG) features:from a mean 1.03 rate per patient of the year 2000, to a mean 1.33 figure in the year 2008. The evolution of assistance features in a Day-Hospital setting, seems strictly linked to the modification of prevailing disorders. A permanent monitoring of the features of health care provision at an Infectious Disease Day-Hospital service may allow to consider significant temporal modifications, and contribute to ensure adequate assistential planning, including the eventual revision of structural, professional, technical, and funding resources.
This article is published under license to BioMed Central Ltd.