The internal medicine services of the National Health System (SNS) have registered a strong increase in both care workload and the number of specialists over the past two decades, but the implementation of the care models considered “priority” continues to be “limited”, according to the conclusions of the study 'RECALMIN VI'.
This work is part of the Resources and Quality in Internal Medicine (RECALMIN) project of the Spanish Society of Internal Medicine, developed together with the Foundation Instituto para la Mejora de la Asistencia Sanitaria, and examines the structure, activity, and results of internal medicine services between 2007 and 2023.
The analysis is based on more than 9.9 million hospital discharges recorded in the period studied and on the data collected in the successive RECALMIN surveys on resources and the organization of internal medicine services.
The report finds a notable increase in medical resources in this specialty. Between 2014 and 2024, the staffing of internists rose from 6.1 to nine professionals per 100,000 inhabitants, which represents growth close to 48 percent.
At the same time, hospital discharges went from 535,056 in 2007 to 697,753 in 2023, an increase of 30.4 percent. At present, these services account for approximately 20 percent of hospital discharges in the SNS. The clinical complexity of the patients treated has also increased, although the average length of stay has remained stable, at around seven days.
Gross hospital mortality rose from 10.7 percent in 2007 to 12.4 percent in 2023. However, after adjusting the results according to patients’ characteristics and risk, no statistically significant deterioration is observed across the overall period analyzed.
The study also reviews the evolution of four very common processes in internal medicine: heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and stroke. In all of them, a relevant reduction in risk-adjusted mortality is observed between 2007 and 2015, followed by a stabilization phase between 2016 and 2023.
For researchers, these data indicate that internal medicine services have been adapting to the increase in care complexity. However, they point out that the change in the coding of the Minimum Basic Data Set (CMBD) in 2016 and the impact of the Covid-19 pandemic make it difficult to accurately read trends over time.
Difficulties in home hospitalization and shared care
The report also highlights significant differences in the implementation of the care models considered "prioritized" for internal medicine. According to the authors, the shortcomings are especially pronounced in home hospitalization and shared care, while they assess positively the expansion of rapid diagnostic consultations.
Specifically, the RECALMIN 2025 survey, in which 137 hospitals participated, shows that only 21 percent of the services have home hospitalization within their organizational structure; and 50 percent offer shared care models with other specialties, especially surgical ones.
45 percent have specific programs or consultations for patients with multiple chronic conditions, compared with 19 percent recorded in 2007; 71 percent have rapid diagnostic consultations, one of the areas that has progressed the most since 2007; and 56 percent have electronic consultation systems with Primary Care.
In the authors' view, population aging, the higher prevalence of chronic diseases, and the growing complexity of patients require moving toward more integrated care models, which strengthen coordination with Primary Care, improve care for patients with multiple chronic conditions, and develop alternatives to conventional hospitalization.