The Treatment of Chronic Disease and Symptoms of an Unknown Etiology in the General Medicine Ward of Tertiary Comprehensive Hospital in Beijing postprint

Abstract: Background  Under the government's great concern and support to the development of general practice，general practice departments have been successively set up in general hospitals. The disciplinary characteristics of general practice has significant advantages in the treatment management of chronic disease and symptoms of an unknown etiology. However，the treatment and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of tertiary comprehensive hospitals is currently unclear. Objective  This study aims to analyze the current situation and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of a tertiary comprehensive hospital，to analyze the existing problems，and explore the direction of continuously improving the management quality and efficiency of the general medicine department. Methods  Taking the general medical ward of Beijing Friendship Hospital，Capital Medical University as an example，the clinical data of all the inpatients since the establishment of the general medical ward of the hospital （from November 2019 to January 2024） were extracted through the electronic medical record system in February 2024. The general conditions，admission sources，discharge diagnoses and prognosis of the participants were analyzed retrospectively. Results  A total of 2 725 cases included in the study. The ages ranged from 12 to 95 years old，with the average age of （57.4±15.8） years old，including 1 400（51.38%） patients aged 60 years and older. The median（quartile） hospitalization time was 7（5~9） days and the median（quartile） hospitalization cost was 9 053.71（6 551.53~12 380.82） yuan. 1 724 cases（63.27%） were admitted from general outpatient clinics and 1 001 cases（36.73%） were transferred from emergency department or specialties. The top three diseases with the largest number of hospital visits were acute pancreatitis（9.06%），abdominal pain（7.41%）and pneumonia（7.30%），respectively. A total of 1 899（69.69%） patients suffered from chronic diseases，1 085（39.81%）patients had multiple diseases coexisting and 1 016（37.18%） patients had polypharmacy. 1 658 patients（60.84%） had a clear diagnosis at admission and 1 067 patients（39.16%） were admitted with one or more symptoms of an unknown etiology. The top three symptoms of an unknown etiology with the largest numbe of hospital visits were abdominal pain（7.41%），dizziness（5.43%） and abdominal distension（5.03%），respectively. The top five systems ranked as the main discharge diagnosis were digestive system in 1 166 cases（42.79%），respiratory system in 334 cases（12.26%），endocrine system in 317 cases（11.63%），cardiovascular system in 279 cases（10.24%） and blood system in 176 cases（6.46%），respectively. The top ten most diagnosed cases were 249 cases（9.14%） of acute pancreatitis，238 cases（8.73%） of pneumonia，220 cases（8.07%） of chronic gastritis，175 cases（6.42%） of type 2 diabetes with chronic complications，174 cases（6.39%） of acute cholecystitis，154 cases（5.65%） of malignant tumors，109 cases（4.00%） of hypertension，73 cases（2.68%） of coronary atherosclerotic heart disease，62 cases（2.28%） of colorectal polyps and 59 cases（2.17%） of thyroid nodules. 2 411 cases（88.48%） were cured and discharged and 96 cases（3.52%） were transferred to specialist departments due to definite specialist diseases were diagnosed. The hospitalization costs of patients with symptoms of an unknown etiology were higher than those with definite diagnosis at admission（P<0.05），and there was no statistical difference in the hospitalization time（P>0.05）.The hospitalization time and costs of patients with chronic diseases were higher than those without chronic diseases（P<0.05）.The hospitalization time and costs of patients with multiple coexisting diseases were higher than those without multiple coexisting diseases（P<0.05）. Conclusion  Inpatients in the general medicine department of the tertiary general hospital cover a wide range of ages. The disease spectrum involves common diseases in multiple systems，chronic diseases and symptoms of an unknown etiology. The coexistence of multiple diseases is common. Thus the general medicine ward meets the basic medical needs of patients. General medicine is closely related to grassroots health institutions，emergency departments and specialties，which is of great significance in the graded diagnosis and treatment of chronic diseases and symptoms of an unknown etiology，as well as in the multidisciplinary diagnosis and treatment. The long length of hospital stay and high hospitalization costs of patients with chronic diseases，symptoms of an unknown etiology and multiple coexisting diseases suggest that general practitioners need to continuously refine management processes and service content in the management process of chronic diseases and symptoms of an unknown etiology as well as continuously improve management quality.