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Goossens LMA, Vemer P, Rutten-van Mölken MPMH. The risk of overestimating cost savings from hospital-at-home schemes: A literature review. Int J Nurs Stud 2020; 109:103652. [PMID: 32569827 DOI: 10.1016/j.ijnurstu.2020.103652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The concept of hospital-at-home means that home treatment is provided to patients who would otherwise have been treated in the hospital. This may lead to lower costs, but estimates of savings may be overstated if inpatient hospital costs are priced incorrectly. OBJECTIVE The objective of this study was to evaluate the quality of cost analyses of hospital-at-home studies for acute conditions published from 1996 through 2019 and to present an overview of evidence. DESIGN Literature review DATA SOURCES: The PubMed and NHS EED databases were searched. REVIEW METHODS The overall quality of studies was evaluated based on Quality of Health Economic Studies (QHES) score, design, sample size, alignment of cost calculation with study perspective, time horizon, use of tariffs or real resource use and clarity of calculations. Furthermore, we systematically assessed whether cost savings were likely to be overestimated, based on criteria about the costing of inpatient hospital days, informal care costs and bias. RESULTS We identified 48 studies. The average QHES score was 60 out of a maximum of 100 points. Almost all studies violated one or more criteria for the risk of overestimation of cost savings. The most frequent problems were the use of average unit prices per inpatient day (not taking into account the decreasing intensity of care) and biased designs. Most studies found cost differences in favour of hospital-at-home; the range varied from savings of €8773 to a cost increase of €2316 per patient. CONCLUSION Overall quality of studies was not good, with some exceptions. Many cost savings were probably overestimated.
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Affiliation(s)
- Lucas M A Goossens
- Erasmus School for Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam 3000, the Netherlands.
| | - Pepijn Vemer
- Erasmus School for Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam 3000, the Netherlands; Department of Pharmacotherapy, Epidemiology & Economics, University of Groningen, P.O. Box 196, 9700 AD, Groningen, the Netherlands
| | - Maureen P M H Rutten-van Mölken
- Erasmus School for Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam 3000, the Netherlands
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Barberan-Garcia A, Ubre M, Pascual-Argente N, Risco R, Faner J, Balust J, Lacy A, Puig-Junoy J, Roca J, Martinez-Palli G. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. Br J Anaesth 2019; 123:450-456. [DOI: 10.1016/j.bja.2019.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/29/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022] Open
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Vitacca M, Montini A, Comini L. How will telemedicine change clinical practice in chronic obstructive pulmonary disease? Ther Adv Respir Dis 2019; 12:1753465818754778. [PMID: 29411700 PMCID: PMC5937158 DOI: 10.1177/1753465818754778] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient's location. In the near future, it is expected that telemedicine will produce changes in work practices, cultural attitudes and organization, which will affect all professional figures involved in the provision of care. The key to optimizing the use of telemonitoring is to correctly identify who the ideal candidates are, at what time they need it, and for how long. The time course of disease progression varies from patient to patient; hence identifying for each patient a 'correct window' for initiating telemonitoring could be the correct solution. In conclusion, as clinicians, we need to identify the specific challenges we face in delivering care, and implement flexible systems that can be customized to individual patients' requirements and adapted to our diverse healthcare contexts.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Respiratory Rehabilitation Division, Via G Mazzini 129, Lumezzane (BS) 25065, Italy
| | - Alessandra Montini
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS Lumezzane (Brescia), Italy
| | - Laura Comini
- Health Directorate, Istituti Clinici Scientifici Maugeri IRCCS Lumezzane (Brescia), Italy
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Abadias Medrano MJ, Yuguero Torres O, Bardés Robles I, Casas-Méndez LF, Barbé F, de Batlle J. Exacerbations of chronic obstructive pulmonary disease: An analysis of the care process in a regional hospital emergency department. Medicine (Baltimore) 2018; 97:e11601. [PMID: 30075531 PMCID: PMC6081059 DOI: 10.1097/md.0000000000011601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/26/2018] [Indexed: 11/25/2022] Open
Abstract
To describe the characteristics of patients visiting a Hospital Emergency Department (HED) due to chronic obstructive pulmonary disease (COPD) exacerbation (AECOPD) and to evaluate their management.A cross-sectional study of the first 219 patients with AECOPD visiting the HED of the University Hospital Arnau de Vilanova, Lleida, Spain, was performed from January to May 2016. The data collected included the following: main patient characteristics, diagnostic tests, applied treatments, response times, discharge destination, need for hospital admission, and re-admissions and deaths at 90 days. Comparisons were made according to sex and need for hospitalization.The patients consisted of 84% men, with a mean age (standard deviation [SD]) of 75.9 (11) years and a FEV1/FVC of 56 (13)%; 63% were ex-smokers. The median time (P25-P75) in the HED was 6 (4-10) hours, with shorter waiting times for severe patients. Additionally, 74% of patients required hospital admission. The percentages of re-admissions and mortality at 90 days were 25% and 14%, respectively. Among female patients, 63% never consumed tobacco, and the most frequent clinical phenotype was asthma combined with COPD; female patients visited the family doctor sooner after AECOPD than men (4 vs 7 days). Overall, the following areas of improvement were identified: use of sputum culture (performed in 3% of patients); documentation of variables; patient care times; and reduction in the time until first medical check-up.The overall quality of care provided to AECOPD patients was satisfactory and consistent with current clinical guidelines. Nevertheless, improving the quality of care at the HED requires establishing protocols that ensure that the necessary diagnostic tests are performed, optimize response times and guarantee that all relevant information is collected.
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Affiliation(s)
- Maria Jose Abadias Medrano
- Emergency Department, Hospital Universitari Arnau de Vilanova de Lleida
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova i Santa Maria, IRBLLEIDA, Lleida
| | - Oriol Yuguero Torres
- Emergency Department, Hospital Universitari Arnau de Vilanova de Lleida
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova i Santa Maria, IRBLLEIDA, Lleida
| | | | - Luis Fernando Casas-Méndez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova i Santa Maria, IRBLLEIDA, Lleida
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova i Santa Maria, IRBLLEIDA, Lleida
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova i Santa Maria, IRBLLEIDA, Lleida
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Mirón Rubio M, Ceballos Fernández R, Parras Pastor I, Palomo Iloro A, Fernández Félix BM, Medina Miralles J, Zamudio López E, González Pastor J, Amador Lorente C, Mena Hortelano N, Domínguez Sánchez A, Alonso-Viteri S. Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease: study TELEPOC. Expert Rev Respir Med 2018; 12:335-343. [PMID: 29460648 DOI: 10.1080/17476348.2018.1442214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD. METHODS Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients' home if an alarm signal was detected. The outcomes were compared to historical data from the same patients. RESULTS The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by €1,860.80 per patient per year. CONCLUSIONS Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.
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Affiliation(s)
- Manuel Mirón Rubio
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | | | | | - Amaya Palomo Iloro
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Borja Manuel Fernández Félix
- d Biostatistic Unit , University Ramón y Cajal Hospital (IRYCIS), CIBER epidemiología y salud pública (CIBERESP) , Madrid , Spain
| | - Jenifer Medina Miralles
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Esther Zamudio López
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Javier González Pastor
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Caridad Amador Lorente
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Nazaret Mena Hortelano
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Alejandro Domínguez Sánchez
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
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Font D, Escarrabill J, Gómez M, Ruiz R, Enfedaque B, Altimiras X. Integrated Health Care Barcelona Esquerra (Ais-Be): A Global View of Organisational Development, Re-Engineering of Processes and Improvement of the Information Systems. The Role of the Tertiary University Hospital in the Transformation. Int J Integr Care 2016; 16:8. [PMID: 27616964 PMCID: PMC5015542 DOI: 10.5334/ijic.2476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/18/2022] Open
Abstract
The Integrated Health Area "Barcelona Esquerra" (Área Integral de Salud de Barcelona Esquerra - AIS-BE), which covers a population of 524,000 residents in Barcelona city, is running a project to improve healthcare quality and efficiency based on co-ordination between the different suppliers in its area through the participation of their professionals. Endowed with an Organisational Model that seeks decision-taking that starts out from clinical knowledge and from Information Systems tools that facilitate this co-ordination (an interoperability platform and a website) it presents important results in its structured programmes that have been implemented such as the Reorganisation of Emergency Care, Screening for Colorectal Cancer, the Onset of type 2 Diabetes Mellitus, Teledermatology and the Development of Cross-sectional Healthcare Policies for Care in Chronicity.
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Affiliation(s)
- David Font
- Strategy and Planning Manager, Hospital Clínic, Barcelona 08036, Spain
- Standing Committee of AIS-BE, Spain
| | - Joan Escarrabill
- Chronic Care Programme Manager. Hospital Clínic – AIS-BE, Spain
- Director Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (Obs TRD) (Ministry of Health), Spain
- REDISSEC (Research Network for Health Services in Chronic Disease), Spain
| | - Mónica Gómez
- Coordinator of the AISBE Technical office, Spain
- Standing Committee of AIS-BE, Spain
| | - Rafael Ruiz
- Eixample Primary Care Consortium (CAPSE) Manager, Spain
- Standing Committee of AIS-BE, Spain
| | - Belén Enfedaque
- Primary Care Manager (SAP Esquerra – Catalan Health Institute), Spain
- Standing Committee of AIS-BE, Spain
| | - Xavier Altimiras
- Integrated Health Area “Barcelona Esquerra” (AIS-BE) Manager. Barcelona Health Consortium (CatSalut), Spain
- Standing Committee of AIS-BE, Spain
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7
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Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, Greenhalgh J, Roland M. Outpatient services and primary care: scoping review, substudies and international comparisons. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | - Ellen Nolte
- RAND Europe, Cambridge, UK
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Greenhalgh
- Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Martin Roland
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Jester R, Titchener K, Doyle-Blunden J, Caldwell C. The development of an evaluation framework for a Hospital at Home service. JOURNAL OF INTEGRATED CARE 2015. [DOI: 10.1108/jica-09-2015-0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service.
Design/methodology/approach
– A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation.
Findings
– Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identified that met the inclusion criteria and included both HH to facilitate early discharge and admission prevention across a wide range of conditions. The key finding was there is a dearth of literature evaluating staff preparation to work on HH, models of delivery, specifically integrated care and trans-disciplinary working and few studies included the experiences of family carers.
Originality/value
– This paper will be of value to those involved in the commissioning and delivery of HH and other models of integrated care services type services and will help to inform evaluation strategies that are practical, evidence based and include all stakeholder perspectives.
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Escarrabill J, Torrente E, Esquinas C, Hernández C, Monsó E, Freixas M, Almagro P, Tresserras R. Auditoría clínica de los pacientes que ingresan en el hospital por agudización de EPOC. Estudio MAG-1. Arch Bronconeumol 2015; 51:483-9. [DOI: 10.1016/j.arbres.2014.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
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Mas MÀ, Santaeugènia S. Hospitalización domiciliaria en el paciente anciano: revisión de la evidencia y oportunidades de la geriatría. Rev Esp Geriatr Gerontol 2015; 50:26-34. [PMID: 24948521 DOI: 10.1016/j.regg.2014.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Miquel Àngel Mas
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Hospital Municipal de Badalona, CSS El Carme, Badalona, Cataluña, España; Universitat Autònoma de Barcelona, Cataluña, España.
| | - Sebastià Santaeugènia
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Hospital Municipal de Badalona, CSS El Carme, Badalona, Cataluña, España; Universitat Autònoma de Barcelona, Cataluña, España
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Petitte TM, Narsavage GL, Chen YJ, Coole C, Forth T, Frick KD. Feasibility study: home telemonitoring for patients with lung cancer in a mountainous rural area. Oncol Nurs Forum 2014; 41:153-61. [PMID: 24578075 DOI: 10.1188/14.onf.153-161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the feasibility of rural home telemonitoring for patients with lung cancer. DESIGN Exploratory, descriptive, observational. SETTING Patient homes within a 75-mile radius of the study hospital in West Virginia. SAMPLE 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. METHODS Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. MAIN RESEARCH VARIABLES Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. FINDINGS Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. CONCLUSIONS Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. IMPLICATIONS FOR NURSING Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.
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Affiliation(s)
- Trisha M Petitte
- Robert C. Byrd Health Sciences Center, School of Nursing at West Virginia University in Morgantown
| | - Georgia L Narsavage
- Robert C. Byrd Health Sciences Center, School of Nursing at West Virginia University in Morgantown
| | - Yea-Jyh Chen
- College of Nursing, Kent State University in Ohio
| | - Charles Coole
- West Virginia University Research Corporation in Morgantown
| | - Tara Forth
- West Virginia University Health System in Morgantown
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD
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12
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Goossens LMA, Utens CMA, Smeenk FWJM, van Schayck OCP, van Vliet M, van Litsenburg W, Braken MW, Rutten-van Mölken MPMH. Cost-effectiveness of early assisted discharge for COPD exacerbations in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:517-528. [PMID: 23796285 DOI: 10.1016/j.jval.2013.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Hospital admissions for exacerbations of chronic obstructive pulmonary disease are the main cost drivers of the disease. An alternative is to treat suitable patients at home instead of in the hospital. This article reports on the cost-effectiveness and cost-utility of early assisted discharge in The Netherlands. METHODS In the multicenter randomized controlled Assessment of GOing Home under Early Assisted Discharge trial (n = 139), one group received 7 days of inpatient hospital treatment (HOSP) and one group was discharged after 3 days and treated at home by community nurses for 4 days. Health care resource use, productivity losses, and informal care were recorded in cost questionnaires. Microcosting was performed for inpatient day costs. RESULTS Seven days after admission, mean change from baseline Clinical Chronic Obstructive Pulmonary Disease Questionnaire score was better for HOSP, but not statistically significantly: 0.29 (95% confidence interval [CI]-0.04 to 0.61). The difference in the probability of having a clinically relevant improvement was significant in favor of HOSP: 19.0%-point (95% CI 0.5%-36.3%). After 3 months of follow-up, differences in effectiveness had almost disappeared. The difference in quality-adjusted life-years was 0.0054 (95% CI-0.021 to 0.0095). From a health care perspective, early assisted discharge was cost saving:-€244 (treatment phase, 95% CI-€315 to-€168) and-€168 (3 months, 95% CI-€1253 to €922). Societal perspective:-€65 (treatment phase, 95% CI-€152 to €25) and €908 (3 months, 95% CI-€553 to €2296). The savings per quality-adjusted life-year lost were €31,111 from a health care perspective. From a societal perspective, HOSP was dominant. CONCLUSIONS No clear evidence was found to conclude that either treatment was more effective or less costly.
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Affiliation(s)
- Lucas M A Goossens
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
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Ito K, Kawayama T, Shoji Y, Fukushima N, Matsunaga K, Edakuni N, Uchimura N, Hoshino T. Depression, but not sleep disorder, is an independent factor affecting exacerbations and hospitalization in patients with chronic obstructive pulmonary disease. Respirology 2013; 17:940-9. [PMID: 22564039 DOI: 10.1111/j.1440-1843.2012.02190.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with chronic obstructive pulmonary disease (COPD) may experience depression and sleep disorders, which can adversely affect their health-related quality of life (HRQOL). The aim of this study was to investigate depression and sleep disorders among 85 COPD patients and 46 control subjects, aged 40 years and over. METHODS Patients underwent spirometry and arterial blood gas analysis, self-completed St. George's respiratory questionnaire and were assessed on the center for epidemiologic studies depression (CES-D) and the Pittsburgh sleep quality index (PSQI). The frequency of exacerbations among COPD patients was prospectively monitored for 12 months. RESULTS The prevalence of depression and sleep disorders was significantly higher among COPD patients than control subjects. The relative risks (95% confidence interval) of depression and sleep disorders were 7.58 (1.03 to 55.8) and 1.82 (1.03 to 3.22), respectively, in COPD patients compared with control subjects. Among COPD patients, there was a correlation between CES-D and PSQI. Lower body mass index, more severe dyspnoea, poorer HRQOL, lower partial pressure of arterial oxygen and higher partial pressure of arterial carbon dioxide were significantly associated with the incidence of depression and sleep disorders. Exacerbations and hospitalizations were more frequent among COPD patients with depression than those with sleep disorders alone or those without depression or sleep disorders. CONCLUSIONS Depression and sleep disorders are very common co-morbidities among COPD patients and significantly reduce activities and HRQOL among these patients. Depression, but not sleep disorder, is an independent risk factor for exacerbations and hospitalization among COPD patients.
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Affiliation(s)
- Kosuke Ito
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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Jeppesen E, Brurberg KG, Vist GE, Wedzicha JA, Wright JJ, Greenstone M, Walters JAE. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012:CD003573. [PMID: 22592692 DOI: 10.1002/14651858.cd003573.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hospital at home schemes are a recently adopted method of service delivery for the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) aimed at reducing demand for acute hospital inpatient beds and promoting a patient-centred approach through admission avoidance. However, evidence in support of such a service is contradictory. OBJECTIVES To evaluate the efficacy of hospital at home compared to hospital inpatient care in acute exacerbations of COPD. SEARCH METHODS Trials were identified from searches of electronic databases, including CENTRAL, MEDLINE, EMBASE, and the Cochrane Airways Group Register (CAGR). The review authors checked the reference lists of included trials. The CAGR was searched up to February 2012. The additional databases were searched up to October 2010. SELECTION CRITERIA We considered randomised controlled trials where patients presented to the emergency department with an exacerbation of their COPD. Studies must not have recruited patients for whom treatment at home is usually not viewed as an responsible option (e.g. patients with an impaired level of consciousness, acute confusion, acute changes on the radiograph or electrocardiogram, arterial pH less than 7.35, concomitant medical conditions). DATA COLLECTION AND ANALYSIS Two review authors independently selected articles for inclusion, assessed the risk of bias and extracted data for each of the included trials. MAIN RESULTS Eight trials with 870 patients were included in the review and showed a significant reduction in readmission rates for hospital at home compared with hospital inpatient care of acute exacerbations of COPD (risk ratio (RR)0.76; 95% confidence interval (CI) from 0.59 to 0.99; P=0.04). Moreover, we observed a trend towards lower mortality in the hospital at home group, but the pooled effect estimate did not reach statistical significance (RR 0.65, 95% CI 0.40 to 1.04, P = 0.07). For health-related quality of life, lung function (FEV1) and direct costs, the quality of the available evidence is in general too weak to make firm conclusions. AUTHORS' CONCLUSIONS Selected patients presenting to hospital emergency departments with acute exacerbations of COPD can be safely and successfully treated at home with support from respiratory nurses. We found evidence of moderate quality that hospital at home may be advantageous with respect to readmission rates in these patients. Treatment of acute exacerbation of COPD in hospital at home also show a trend towards reduced mortality rate when compared with conventional inpatient treatment, but these results did not reach statistical significance (moderate quality evidence). For other outcomes than readmission and mortality rate, we assessed the evidence to be of low or very low quality.
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Utens CMA, Maarse JAM, van Schayck OCP, Maesen BLP, Rutten MPMH, Smeenk FWJM. Care delivery pathways for Chronic Obstructive Pulmonary Disease in England and the Netherlands: a comparative study. Int J Integr Care 2012; 12:e40. [PMID: 22977431 PMCID: PMC3440249 DOI: 10.5334/ijic.811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/15/2012] [Accepted: 02/28/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD) is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. METHODS Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. RESULTS The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England), the differences in funding (funding in England facilitated the development of hospital-at-home) and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England). DISCUSSION AND CONCLUSION The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands.
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Affiliation(s)
- Cecile M A Utens
- Department of Respiratory Medicine, Catharina-hospital Eindhoven, P.O. Box 1350 5602 ZA Eindhoven, The Netherlands
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Casas Méndez LF, Montón Soler C, Baré Mañas M, Casabon Salas J, Pomares Amigó X, Aguirre Larracoechea U. Hospital de día de enfermedades respiratorias: impacto sobre la tasa de ingresos hospitalarios por exacerbaciones de la enfermedad pulmonar obstructiva crónica. Med Clin (Barc) 2011; 136:665-8. [DOI: 10.1016/j.medcli.2010.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/22/2010] [Accepted: 07/27/2010] [Indexed: 11/16/2022]
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Singh R, Rowan J, Burton C, Galletly C. How effective is a hospital at home service for people with acute mental illness? Australas Psychiatry 2010; 18:512-6. [PMID: 21117838 DOI: 10.3109/10398562.2010.526214] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hospital at home (HAH) services have been developed to replace traditional inpatient care but there is little recent published data about their efficacy. This study evaluates HAH treatment for people with an acute episode of psychiatric illness who would otherwise have been admitted to hospital. METHOD The staffing and operation of the service is described, along with admission criteria. Patients could be visited by the HAH team up to three times a day, 7 days a week. Data were collected for 1 year. Demographic data, diagnoses, referral, discharge pathways, and outcomes are presented. RESULTS One hundred and eleven people were admitted to HAH. The most common diagnoses were mood disorders and non-affective psychoses. The mean length of stay was 17 days with an average of 22 home visits to each patient. Twenty percent of patients were transferred to inpatient services. For those who completed their treatment with HAH, symptom improvement and length of stay were comparable to inpatient services. There was only one adverse event, an episode of self harm. CONCLUSIONS HAH services can provide a safe, effective alternative to inpatient care for suitable patients. Home treatment has the potential to reduce costs, reduce the pressure on inpatient services and provide care that is acceptable to patients and their families.
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Affiliation(s)
- Rajan Singh
- North East Hospital at Home, Central Northern Adelaide Health Service, Adelaide, SA, Australia
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Utens CMA, Goossens LMA, Smeenk FWJM, van Schayck OCP, van Litsenburg W, Janssen A, van Vliet M, Seezink W, Demunck DRAJ, van de Pas B, de Bruijn PJ, van der Pouw A, Retera JMAM, de Laat-Bierings P, van Eijsden L, Braken M, Eijsermans R, Rutten-van Mölken MPMH. Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: the design of a randomised controlled trial. BMC Public Health 2010; 10:618. [PMID: 20955582 PMCID: PMC2965725 DOI: 10.1186/1471-2458-10-618] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are the main cause for hospitalisation. These hospitalisations result in a high pressure on hospital beds and high health care costs. Because of the increasing prevalence of COPD this will only become worse. Hospital at home is one of the alternatives that has been proved to be a safe alternative for hospitalisation in COPD. Most schemes are early assisted discharge schemes with specialised respiratory nurses providing care at home. Whether this type of service is cost-effective depends on the setting in which it is delivered and the way in which it is organised. METHODS/DESIGN GO AHEAD (Assessment Of Going Home under Early Assisted Discharge) is a 3-months, randomised controlled, multi-centre clinical trial. Patients admitted to hospital for a COPD exacerbation are either discharged on the fourth day of admission and further treated at home, or receive usual inpatient hospital care. Home treatment is supervised by general nurses. Primary outcome is the effectiveness and cost effectiveness of an early assisted discharge intervention in comparison with usual inpatient hospital care for patients hospitalised with a COPD exacerbation. Secondary outcomes include effects on quality of life, primary informal caregiver burden and patient and primary caregiver satisfaction. Additionally, a discrete choice experiment is performed to provide insight in patient and informal caregiver preferences for different treatment characteristics. Measurements are performed on the first day of admission and 3 days, 7 days, 1 month and 3 months thereafter. Ethical approval has been obtained and the study has been registered. DISCUSSION This article describes the study protocol of the GO AHEAD study. Early assisted discharge could be an effective and cost-effective method to reduce length of hospital stay in the Netherlands which is beneficial for patients and society. If effectiveness and cost-effectiveness can be proven, implementation in the Dutch health care system should be considered. TRIAL REGISTRATION Netherlands Trial Register NTR1129.
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Affiliation(s)
- Cecile MA Utens
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Lucas MA Goossens
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands
| | - Frank WJM Smeenk
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Onno CP van Schayck
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Walter van Litsenburg
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Annet Janssen
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Monique van Vliet
- Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, the Netherlands
| | - Wiel Seezink
- Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, the Netherlands
| | - Dirk RAJ Demunck
- Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven/Eindhoven, the Netherlands
| | - Brigitte van de Pas
- Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven/Eindhoven, the Netherlands
| | - Peter J de Bruijn
- Department of Respiratory Medicine, Alysis zorggroep Rijnstate Arnhem, Arnhem, the Netherlands
| | - Anouschka van der Pouw
- Department of Respiratory Medicine, Alysis zorggroep Rijnstate Arnhem, Arnhem, the Netherlands
| | - Jeroen MAM Retera
- Department of Respiratory Medicine, TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Loes van Eijsden
- Department of Health Care Policy, Meander Group Zuid-Limburg, Heerlen, the Netherlands
| | - Maria Braken
- Department of Staff Nurses Nursing and Care, ZuidZorg, Veldhoven, the Netherlands
| | - Riet Eijsermans
- Department of Transmural Care, Thebe, Tilburg, the Netherlands
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