Trends in the structure, activity, and outcomes of Internal Medicine Services in the National Health System (2007-2024): The RECALMIN Study VI.

OBJECTIVES: To analyse the evolution of the structure, activity and outcomes of Internal Medicine Departments (IMDs) within the Spanish National Health System (SNHS) between 2007 and 2024, and to assess their alignment with the strategic priorities of the specialty. METHODS: Observational study based on two data sources: (1) the RECALMIN survey on IMD structure and activity, and (2) the Minimum Basic Data Set (CMBD), including more than 9.9 million hospital discharges. Temporal trends were analysed using Poisson regression models and risk-adjusted models for hospital mortality. RESULTS: Over the study period, a significant increase was observed in the number of internists per population (IRR = 1.04-1.06), as well as in hospital activity and patient complexity. IMDs account for approximately 20% of all hospital discharges within the SNHS. Crude hospital mortality increased, whereas risk-adjusted mortality showed a declining trend until 2015 followed by subsequent stabilisation. The implementation of key organisational models (hospital-at-home programmes, co-management models, and care pathways for complex chronic patients) remains limited. CONCLUSIONS: IMDs have experienced a sustained increase in activity and case complexity over the past two decades, while maintaining overall stable risk-adjusted outcomes. However, a gap persists between the growing care burden and the implementation of organisational models aligned with the strategic direction of the specialty.