TY - JOUR
T1 - Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors
AU - Inzitari, Marco
AU - Mas, Miquel Àngel
AU - Durán, Xavier
AU - Miralles, Ramón
AU - Renom-Guiteras, Anna
N1 - Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - © 2018 SEGG Introduction: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. Methods: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥ 35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. Results: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95% CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. Conclusions: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.
AB - © 2018 SEGG Introduction: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. Methods: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥ 35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. Results: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95% CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. Conclusions: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.
KW - Disabling acute processes
KW - Community rehabilitation
KW - Integrated care
KW - Hospital-at-home
KW - Prognostic factors
UR - http://www.mendeley.com/research/hospitalathome-integrated-care-programme-tailored-older-patients-disabling-acute-processes-identific
UR - https://dialnet.unirioja.es/servlet/articulo?codigo=7934687
U2 - 10.1016/j.regg.2018.11.005
DO - 10.1016/j.regg.2018.11.005
M3 - Article
C2 - 30792139
SN - 0211-139X
VL - 54
SP - 136
EP - 142
JO - Revista Espanola de Geriatria y Gerontologia
JF - Revista Espanola de Geriatria y Gerontologia
ER -