Clinical complexity and hospital admissions in the December holiday period
Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital du...
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| creator | Lenti, Marco Vincenzo Klersy, Catherine Brera, Alice Silvia Musella, Valeria Benedetti, Irene Padovini, Lucia Ciola, Mariella Croce, Gabriele Ballesio, Alessia Gorgone, Maria Fortunata Bertolino, Giampiera Di Sabatino, Antonio Corazza, Gino Roberto |
| description | Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period. This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed. Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p |
| doi_str_mv | 10.1371/journal.pone.0234112 |
| format | Article |
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In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period. This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed. Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0234112</identifier><identifier>PMID: 32525896</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Age ; Biology and Life Sciences ; Biometrics ; Christmas ; Cognitive ability ; Complexity ; Correlation analysis ; Dementia ; Demographic aspects ; Deprivation ; Enrollments ; Epidemiology ; Evaluation ; Family physicians ; Females ; Forecasts and trends ; Health aspects ; Holidays ; Holidays & special occasions ; Hospital admission and discharge ; Hospitalization ; Hospitals ; Income ; Influence ; Internal medicine ; Longitudinal studies ; Medicine ; Medicine and Health Sciences ; Mortality ; New year ; Patients ; People and Places ; Regression analysis ; Resource allocation ; Risk analysis ; Risk factors ; Social Sciences ; Socioeconomics ; Statistical analysis ; Variables</subject><ispartof>PloS one, 2020-06, Vol.15 (6), p.e0234112-e0234112</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Lenti et al. 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Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.</description><subject>Age</subject><subject>Biology and Life Sciences</subject><subject>Biometrics</subject><subject>Christmas</subject><subject>Cognitive ability</subject><subject>Complexity</subject><subject>Correlation analysis</subject><subject>Dementia</subject><subject>Demographic aspects</subject><subject>Deprivation</subject><subject>Enrollments</subject><subject>Epidemiology</subject><subject>Evaluation</subject><subject>Family physicians</subject><subject>Females</subject><subject>Forecasts and trends</subject><subject>Health aspects</subject><subject>Holidays</subject><subject>Holidays & special occasions</subject><subject>Hospital admission and discharge</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Income</subject><subject>Influence</subject><subject>Internal 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one</jtitle><date>2020-06-11</date><risdate>2020</risdate><volume>15</volume><issue>6</issue><spage>e0234112</spage><epage>e0234112</epage><pages>e0234112-e0234112</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period. This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed. Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32525896</pmid><doi>10.1371/journal.pone.0234112</doi><tpages>e0234112</tpages><orcidid>https://orcid.org/0000-0002-6291-8242</orcidid><orcidid>https://orcid.org/0000-0002-6654-4911</orcidid><orcidid>https://orcid.org/0000-0002-3562-5321</orcidid><orcidid>https://orcid.org/0000-0001-9532-0573</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2412205051 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Age Biology and Life Sciences Biometrics Christmas Cognitive ability Complexity Correlation analysis Dementia Demographic aspects Deprivation Enrollments Epidemiology Evaluation Family physicians Females Forecasts and trends Health aspects Holidays Holidays & special occasions Hospital admission and discharge Hospitalization Hospitals Income Influence Internal medicine Longitudinal studies Medicine Medicine and Health Sciences Mortality New year Patients People and Places Regression analysis Resource allocation Risk analysis Risk factors Social Sciences Socioeconomics Statistical analysis Variables |
| title | Clinical complexity and hospital admissions in the December holiday period |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T23%3A49%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20complexity%20and%20hospital%20admissions%20in%20the%20December%20holiday%20period&rft.jtitle=PloS%20one&rft.au=Lenti,%20Marco%20Vincenzo&rft.date=2020-06-11&rft.volume=15&rft.issue=6&rft.spage=e0234112&rft.epage=e0234112&rft.pages=e0234112-e0234112&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0234112&rft_dat=%3Cgale_plos_%3EA626371008%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2412205051&rft_id=info:pmid/32525896&rft_galeid=A626371008&rft_doaj_id=oai_doaj_org_article_5c60d08e63c4427d8455516e797efd9f&rfr_iscdi=true |