Internal Medicine

Biography

Biography: Filomena Pietrantonio

Abstract

Chronic diseases are the major cause of death (59%) and disability, 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards focusing on  the management of acute medical patients. Methods. To better manage polypathological patients requiring hospitalizationl we propose the hospital counterpart of Chronic Care Model (CCM), the Acute Complex Care Model (ACCM).  Target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring continuous monitoring and  high technology resources. The mission is to improve the AICPPs management through pre-defined intra-hospital tracks and a global, multidisciplinary, patient centered approach. The ACCM leader is internal medicine specialist (IMS) who summarizes health problems, establishes priorities and restores health balance in AICPPs. Admitted patients, evaluated according to validated  criteria, should be allocated in High Dependency Areas (HDAs) to receive more frequent clinical and  nursing  monitoring  than in ordinary wards, even if less than in Intensive Care Unit. ACCM  advantage is patient safety, thanks to a more favorable nurse/patients ratio, quicker responses to changes in clinical conditions, and more functional allocation of resources. Results. Preliminary data collected in  two Rome MD (50 patients)  showed:  mean age 73 years, more than 4 active comorbidities, need of continous monitoring,  high technology resources, an average of 4 urgent investigations  and 2 specialists consultations performed during the first 72h from admission.  Conclusions: Epidemiological transition leading to a progressive increase in “chronically unstable” patients needing frequent hospitalizations, enhances the role of hospital IMS. ACCM represents a practical response to this epochal change of roles