Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

Abstract

Background: Understanding the most common and costly conditions treated by inpatient general medical services is important for implementing quality improvement, developing health policy, conducting research, and designing medical education.

Objective: To determine the prevalence and cost of conditions treated on general internal medicine (GIM) inpatient services.

Design: Retrospective cross-sectional study involving 7 hospital sites in Toronto, Canada.

Participants: All patients discharged between April 1, 2010 and March 31, 2015 who were admitted to or discharged from an inpatient GIM service.

Main measures: Hospital administrative data were used to identify diagnoses and costs associated with admissions. The primary discharge diagnosis was identified for each admission and categorized into clinically relevant and mutually exclusive categories using the Clinical Classifications Software (CCS) tool.

Key results: 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%). The prevalence of the 20 most common conditions was significantly correlated across hospitals (correlation coefficients ranging from 0.55 to 0.95, p ≤ 0.01 for all comparisons). No single condition represented more than 5.1% of all admissions or more than 7.9% of admissions at any hospital site. The costliest conditions were stroke (median cost $7122, interquartile range 5587-12,354, total cost $94,199,422, representing 6.0% of all costs) and the group of delirium, dementia, and cognitive disorders (median cost $12,831, IQR 9539-17,509, 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 remaining hospitalizations included 223 different CCS conditions.

Conclusions: GIM services care for a markedly heterogeneous population but the most common conditions were similar across 7 hospitals. 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.

Keywords: cost; diagnoses; health services research; hospitalist; internal medicine.

Fig. 1

Prevalence and cost of the most common primary discharge diagnoses in GIM. Primary discharge diagnosis was categorized using the CCS tool. Prevalence is denoted by the size of each box, and cost in Canadian dollars is denoted by color. “Other” represents all remaining conditions and is comprised of 213 CCS conditions and one group of “uncategorized” diagnoses (0.9%). For clarity of presentation, we simplified the description of CCS conditions. COPD: chronic obstructive pulmonary disease, GI; gastrointestinal, DM: diabetes mellitus.