Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.
Por:
Closa C, Mas MÀ, Sebastià Santaeugènia Gonzàlez, Inzitari M, Ribera A and Gallofré M
Publicada:
1 sep 2017
Ahead of Print:
31 may 2017
Resumen:
OBJECTIVE: To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. DESIGN: Quasi-experimental longitudinal study. SETTING: An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. PARTICIPANTS: In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. INTERVENTION: Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. MEASUREMENTS: We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. RESULTS: No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P < .001. Length of acute hospital stay was significantly shorter in patients discharged to home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P < .001]. CONCLUSION: The hospital-at-home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs.
Filiaciones:
Closa C:
Department of Physical Medicine and Rehabilitation, Corporación Fisiogestión, Barcelona, Spain
Mas MÀ:
Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain
Universitat Autònoma de Barcelona, Catalonia, Spain
Sebastià Santaeugènia Gonzàlez:
Chronic Care Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain
Inzitari M:
Universitat Autònoma de Barcelona, Catalonia, Spain
Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
Ribera A:
Cardiovascular Epidemiology Unit, Cardiology Department, CIBERESP, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
Stroke Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain
Gallofré M:
Stroke Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain
Open Access
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