1
|
Cornelis J, Christiaens W, de Meester C, Mistiaen P. Remote patient monitoring in patients with COVID-19 at home: literature review. JMIR Nurs 2024. [PMID: 39287362 DOI: 10.2196/44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND During the pandemic healthcare providers implemented remote patient monitoring (RPM) for patients suffering from COVID-19. RPM is an interaction between healthcare professionals and patients who are in different locations, in which a certain number of patient's functioning parameters is assessed and followed up for a certain duration of time. By implementing RPM for these patients they obtained to reduce the strain on hospitals and primary care. OBJECTIVE With this literature review we aim at describing the characteristics of the RPM interventions, reporting on the patients with COVID-19 included in RPM, and providing an overview of outcome variables such as length of stay (LOS), hospital (re)admissions, and mortality. METHODS A combination of different searches in several database types (traditional databases, trial registers, daily (google) searches and daily Pubmed alerts) were run daily from March 2020 till December 2021. A search update for randomized clinical trials (RCT's) was done in April 2022. RESULTS The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centres. None of the 164 studies covering 248,431 included patients reported on the presence of a randomized control group. Studies described a 'prehosp' group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and for whom it was decided not to hospitalize them yet, but closely monitor them at home, or a 'posthosp' group (32 studies) with patients who were monitored at home after hospitalization for COVID-19; 34 studies described both groups, in 2 studies it was unclear. There is a large variety in number of emergency department (ED) visits (0-36% and 0-16%) and no convincing evidence that RPM leads to less or more ED-visits as well as hospital (re)admissions (0-30% and 0-22%) in prehosp and posthosp, respectively. Mortality was generally low, and there is weak to no evidence that RPM is associated with lower mortality. There is neither evidence that RPM shortens previous LOS. A literature update detected three small scale RCT's which could not demonstrate statistically significant differences in these outcomes. Most papers claim savings, however the scientific base for these claims is doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy, etc.). CONCLUSIONS Based on these results, there is no convincing evidence that RPM in COVID-19 patients could avoid ED-visits or hospital (re)admissions, could shorten LOS or reduce mortality, but neither is there evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. CLINICALTRIAL
Collapse
Affiliation(s)
- Justien Cornelis
- Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, Brussels, BE
| | | | | | | |
Collapse
|
2
|
Duque-Molina C, García-Rodríguez G, Zaragoza-Jiménez CA, Torre-Rosas ADL, Herrera-Canales M, Loera-Rosales MJ, Pérez-Cardoso AL, Villa-Reyes T, Romo-Rodríguez R, Sánchez-Morales SM, Contreras-Hernández I, Rivas-Ruiz R, Castro-Escamilla O, Ferat-Osorio E, Berlanga-Taylor AJ, Pelayo R, Robledo-Aburto Z, Bonifaz LC, Alcocer-Varela J. Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command. Arch Med Res 2024; 56:103073. [PMID: 39260120 DOI: 10.1016/j.arcmed.2024.103073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization. AIM To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19. MATERIALS AND METHODS The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states). RESULTS At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2. CONCLUSIONS COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.
Collapse
Affiliation(s)
- Célida Duque-Molina
- Unidad de Atención a la Salud, Órgano Público Descentralizado IMSS-Bienestar, Mexico City, Mexico
| | | | | | | | | | - Miriam Jackeline Loera-Rosales
- Comisiones de Evidencia y Manejo de Riesgos, Comisón Federal para la Protección contra Riesgos Sanitarios, Mexico City, Mexico
| | | | - Tania Villa-Reyes
- Servicios de Atención en primer nivel, Órgano Público Descentralizado, IMSS-Bienestar, Mexico City, Mexico
| | - Rubí Romo-Rodríguez
- Laboratorio de Citómica del Cáncer Infantil, Centro de Investigación Biomédica de Oriente, Delegación Puebla, Instituto Mexicano del Seguro Social, Puebla, Mexico; Consejo Nacional de Humanidades, Ciencias y Tecnologías, Mexico City, Mexico
| | - Sofhya Marylett Sánchez-Morales
- Division de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Iris Contreras-Hernández
- Division de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rodolfo Rivas-Ruiz
- Division de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Octavio Castro-Escamilla
- Division de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eduardo Ferat-Osorio
- Division de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Antonio J Berlanga-Taylor
- Unidad de Educación e Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rosana Pelayo
- Unidad de Educación e Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zoe Robledo-Aburto
- Direccion General del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Bonifaz
- Coordinación de Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | |
Collapse
|
3
|
Peinovich M, DeGrado J, Cotugno MC, Gokani R, Wilks E, Shetty P, Hey-Hadavi J. Parenteral medication use in hospital at home: Challenges and opportunities. Am J Health Syst Pharm 2024; 81:e443-e453. [PMID: 38804178 PMCID: PMC11261511 DOI: 10.1093/ajhp/zxae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
| | - Jeremy DeGrado
- Department of Pharmacy Services, Brigham & Women’s Hospital, Boston, MA, USA
| | - Michael C Cotugno
- Department of Pharmacy Services, Brigham & Women’s Hospital, Boston, MA, USA
| | - Raj Gokani
- Global Medical Affairs, Pfizer, Inc., Walton Oaks, UK
| | | | - Pradeep Shetty
- Global Medical Affairs, Pfizer India Limited, Mumbai, India
| | | |
Collapse
|
4
|
Puchi C, Paravic-Klijn T, Salazar A. Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi. Qual Manag Health Care 2024:00019514-990000000-00076. [PMID: 39038040 DOI: 10.1097/qmh.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND OBJECTIVES The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique. METHODS The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts. RESULTS Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care. CONCLUSIONS The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.
Collapse
Affiliation(s)
- Carolina Puchi
- Author Affiliation: Faculty of Nursing, Universidad de Concepción, Concepción, Chile
| | | | | |
Collapse
|
5
|
Williams C, Paulson N, Sweat J, Rutledge R, Paulson MR, Maniaci M, Burger CD. Individual- and Community-Level Predictors of Hospital-at-Home Outcomes. Popul Health Manag 2024; 27:168-173. [PMID: 38546504 DOI: 10.1089/pop.2023.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.
Collapse
Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Nels Paulson
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Rachel Rutledge
- Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA
| | - Margaret R Paulson
- Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Michael Maniaci
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
6
|
Sandreva T, Larsen MN, Rasmussen MK, Nielsen TL, von Sydow C, Schmidt TA, Fischer TK. Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study. J Telemed Telecare 2024:1357633X241254572. [PMID: 38780386 DOI: 10.1177/1357633x241254572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. METHODS A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. RESULTS Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. CONCLUSIONS The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.
Collapse
Affiliation(s)
- Tatjana Sandreva
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maria Normand Larsen
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Infectious and Pulmonary Disease, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Charlotte von Sydow
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Thomas Andersen Schmidt
- Department of Emergency Medicine, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea K Fischer
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Tsujimoto Y, Kobayashi M, Oku T, Ogawa T, Yamadera S, Tsukamoto M, Matsuda N, Nishihira M, Terauchi Y, Tanaka T, Kawabata Y, Miyamoto Y, Morikami Y. Outcomes in novel hospital-at-home model for patients with COVID-19: a multicentre retrospective cohort study. Fam Pract 2023; 40:662-670. [PMID: 36723907 PMCID: PMC10745271 DOI: 10.1093/fampra/cmad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with coronavirus disease (COVID-19). Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organized by a team of local primary care clinics. METHODS We conducted a multicentre retrospective cohort study of the COVID-19 patients who received our HaH care from 1 January to 31 March 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka city were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. RESULTS Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only 1 home visit in addition to online treatment. CONCLUSIONS The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.
Collapse
Affiliation(s)
- Yasushi Tsujimoto
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoecho, Sakyo-ku, Kyoto, Japan
| | | | - Tomohisa Oku
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
| | - Takahisa Ogawa
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
| | | | | | | | | | - Yu Terauchi
- Terauchi Clinic, Dotonbori 1 Chomehigashi 5-5, Chuo-ku, Osaka, Japan
| | - Takahiro Tanaka
- Minato Clinic, Nagarahigashi 1-4-24-102, Kita-ku, Osaka, Japan
| | | | - Yuki Miyamoto
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
| | - Yoshiki Morikami
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
| | | |
Collapse
|
8
|
Boeijen JA, van de Pol AC, van Uum RT, Smit K, Ahmad A, van Rijswijk E, van Apeldoorn MJ, van Thiel E, de Graaf N, Menkveld RM, Mantingh MR, Geertman S, Couzijn N, van Groenendael L, Schers H, Bont J, Bonten TN, Rutten FH, Zwart DLM. Home-based initiatives for acute management of COVID-19 patients needing oxygen: differences across The Netherlands. BMC Health Serv Res 2023; 23:1257. [PMID: 37968634 PMCID: PMC10652550 DOI: 10.1186/s12913-023-10191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. METHODS Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. RESULTS Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. CONCLUSIONS We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.
Collapse
Affiliation(s)
- Josi A Boeijen
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - Alma C van de Pol
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Rick T van Uum
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Karin Smit
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Abeer Ahmad
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Eric van Rijswijk
- Primary Care Network Jeroen Bosch Huisartsen, Nieuwe Linie 231-232, Vught, 5264PJ, The Netherlands
| | - Marjan J van Apeldoorn
- Department of Internal Medicine, Jeroen Bosch Hospital, Postbus 90153, 's-Hertogenbosch, 5200 ME, The Netherlands
| | - Eric van Thiel
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - Netty de Graaf
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - R Michiel Menkveld
- Wilhelmina Hospital Assen, Europaweg-Zuid 1, Postbus 30001, Assen, 9400 RA, The Netherlands
| | - Martijn R Mantingh
- Regional Organization for General Practice Drenthe, Dokter Drenthe, Stationsstraat 44, Assen, 9401 KX, The Netherlands
| | - Silke Geertman
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Nicolette Couzijn
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Leon van Groenendael
- Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen, 6525 EZ, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen, 6525 EZ, The Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Tobias N Bonten
- Public Health & Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Dorien L M Zwart
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| |
Collapse
|
9
|
Hattingh HL, Edmunds C, Buksh S, Cronin S, Gillespie BM. COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit. PHARMACY 2023; 11:157. [PMID: 37888502 PMCID: PMC10610024 DOI: 10.3390/pharmacy11050157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care. METHOD A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out. RESULTS One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period. CONCLUSION Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.
Collapse
Affiliation(s)
- H. Laetitia Hattingh
- Allied Health Research, Gold Coast Health, Gold Coast, QLD 4215, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy, the University of Queensland, Brisbane, QLD 4102, Australia
| | - Catherine Edmunds
- Medical Services, Clinical Governance and Research, Gold Coast Health, Gold Coast, QLD 4215, Australia;
| | - Saberina Buksh
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Sean Cronin
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Brigid M. Gillespie
- NHMRC Wiser Wounds CRE, MHIQ, Griffith University, Gold Coast, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast, QLD 4215, Australia
| |
Collapse
|
10
|
Karlsen L, Mjølstad BP, Løfaldli BB, Helvik AS. Family caregiver involvement and role in hospital at home for adults: the patients' and family caregivers' perspective - a Norwegian qualitative study. BMC Health Serv Res 2023; 23:499. [PMID: 37198679 PMCID: PMC10189695 DOI: 10.1186/s12913-023-09531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hospital at home (HaH) provides acute healthcare services in patients' homes instead of traditional in-patient care. Research has reported positive outcomes for patients and reduced costs. Although HaH has developed into a global concept, we have little knowledge about the involvement and role of family caregivers (FCs) of adults. The aim of this study was to explore FC involvement and role during HaH treatment as perceived by patients and FCs in a Norwegian healthcare context. METHODS A qualitative study was carried out among seven patients and nine FCs in Mid-Norway. The data was obtained through fifteen semi-structured interviews; fourteen were performed individually and one as duad interview. The age of the participants varied between 31 and 73 years, and mean age of 57 years. A hermeneutic phenomenological approach was used, and the analysis was performed according to Kvale and Brinkmann's description of interpretation. RESULTS We identified three main categories and seven subcategories regarding FC involvement and role in HaH: (1) Preparing for something new and unfamiliar, including the subcategories `Lack of involvement in the decision process` and `Information overload affecting caregiver readiness`, (2) Adjusting to a new everyday life at home, including the subcategories `The critical first days at home`, `Coherent care and support in a novel situation`, and `Prior established family roles influencing the new everyday life at home`, (3) FCs` role gradually diminishes and looking back, including the subcategories `A smooth transition to life beyond hospital at home` and `Finding meaning and motivation in providing care`. CONCLUSIONS FCs played an important role in HaH, although their tasks, involvement and effort varied across different phases during HaH treatment. The study findings contribute to a greater understanding of the dynamic nature of the caregiver experiences during HaH treatment, which can guide healthcare professionals on how they can provide timely and appropriate support to FCs in HaH over time. Such knowledge is important to decrease the risk of caregiver distress during HaH treatment. Further work, such as longitudinal studies, should be done to examine the course of caregiving in HaH over time to correct or support the phases described in this study.
Collapse
Affiliation(s)
- Lillian Karlsen
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway.
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway.
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Trondheim, Norway
| | - Bjarte Bye Løfaldli
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway
| | - Anne-Sofie Helvik
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway
| |
Collapse
|
11
|
Ko SQ, Wang Z, Premkumar A, Tey YQ, Koh S, Lim YW, Maier AB. Continuous Vital Signs Monitoring in Patients Hospitalized at Home: Burden or Benefit? J Am Med Dir Assoc 2023; 24:759-760. [PMID: 37011887 PMCID: PMC10064244 DOI: 10.1016/j.jamda.2023.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/12/2023] [Accepted: 02/25/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Stephanie Q Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital
| | - Zhemin Wang
- Division of Advanced Internal Medicine, Department of Medicine, Alexandra Hospital
| | - Aparna Premkumar
- Yong Loo Lin School of Medicine, National University of Singapore.
| | - Ying Qi Tey
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Shuhua Koh
- Regional Health Service, National University Health Systems
| | - Yee Wei Lim
- Medical Affairs, Research, Innovation and Enterprise, Alexandra Hospital, Yong Loo Lin School of Medicine, National University of Singapore
| | - Andrea B Maier
- Department of Medicine, National University of Singapore
| |
Collapse
|
12
|
Miyamoto Y, Matsumura Y, Sumiyoshi S, Morikami Y, Nagao M. Hospital-at-home care for immunodeficient patients with COVID-19: Approach to persistent COVID-19 infection. Clin Case Rep 2023; 11:e7294. [PMID: 37151938 PMCID: PMC10160423 DOI: 10.1002/ccr3.7294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message Patients with COVID-19 who have undergone B-cell depletion therapy could have prolonged SARS-CoV-2 infection; therefore, even in the hospital-at-home setting, primary care physicians should carefully consider the treatment regimen and the timing of ending isolations in such cases, and should not hesitate to consult with infectious disease specialists if necessary. Abstract We presented the first reported case of hospital-at-home care for a patient with persistent COVID-19 who had undergone B-cell depletion therapy. He received hospital-at-home care, including two courses of remdesivir; however, he ultimately failed to recover and was transferred to the hospital.
Collapse
Affiliation(s)
- Yuki Miyamoto
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
- Yoshiki Home Care ClinicKyotoJapan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory MedicineKyoto University Graduate School of MedicineKyotoJapan
| | | | | | - Miki Nagao
- Department of Clinical Laboratory MedicineKyoto University Graduate School of MedicineKyotoJapan
| |
Collapse
|
13
|
Ko SQ, Chua CMS, Koh SH, Lim YW, Shorey S. Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study. J Gen Intern Med 2023; 38:691-698. [PMID: 36008593 PMCID: PMC9409616 DOI: 10.1007/s11606-022-07765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospital at Home (HaH) programs have been shown to improve clinical outcomes, quality of care, and patient satisfaction. However, how Asian patients experience HaH remained underexplored. OBJECTIVE To explore the perceptions and experiences of patients and caregivers admitted to a hospital-at-home program in Singapore. DESIGN Descriptive qualitative study design. PARTICIPANTS Purposive sampling was used to conduct 36 interviews with 13 patients, nine Legally Acceptable Representatives (LARs), and 14 caregivers until data saturation was achieved. INTERVENTIONS NUHS@Home is a HaH program providing care through a multi-disciplinary team, enabled by remote vital signs monitoring through a tablet and wireless blood pressure and oxygen meters. APPROACH This study used in-depth semi-structured individual interviews. Interviews were transcribed and thematically analyzed using Braun and Clark's six-step inductive approach. KEY RESULTS The overarching theme identified was "Enablers, difficulties, and improvements to the HaH experiences" which was supported by three key themes: (1) Perceived better care at home, (2) Importance of social support, and (3) Organizational structures required to support HaH. Participants described overall HaH experiences around factors contributing to their impeding engagement, overall satisfaction, and quality of care. CONCLUSIONS Although HaH is unfamiliar to the Singapore population, most of the participants in this study had an overall positive experience. The key challenges found in this paper were the stress and inconvenience caused to caregivers. The enablers for positive HaH experiences were (1) consideration of patient's family members as key participants in the patients' therapeutic alliance; (2) the HaH care team must be accessible, approachable, and reassuring, and communicate frequently and timely with patients and their families; and (3) financing strategies to ensure HaH out-of-pockets costs remain affordable which are critical to keeping HaH as an option for patients and families.
Collapse
Affiliation(s)
- Stephanie Qianwen Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Shu Hua Koh
- CareHub, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Medical Affairs - Research, Innovation & Enterprise, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
| |
Collapse
|
14
|
Pereta I, Morancho A, López N, Ibáñez B, Salas C, Moreno L, Castells E, Barta A, Cubedo M, Coloma E, Cardozo C, García-Pouton N, Ugarte A, Rivero A, Bodro M, Rico V, García L, Altés J, Seijas N, Nicolás D. Hospital at home treatment with remdesivir for patients with COVID-19: real-life experience. Int J Infect Dis 2023; 127:124-128. [PMID: 36521589 PMCID: PMC9744477 DOI: 10.1016/j.ijid.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Access and appropriateness of therapeutics for COVID-19 vary because of access or regulatory barriers, the severity of the disease, and for some therapies, the stage of the pandemic and circulating variants. Remdesivir has shown benefits in clinical recovery and is the treatment of choice for selected patients, both hospitalized and nonhospitalized, in main international guidelines. The use of remdesivir in alternatives to conventional hospitalization such as hospital at home (HaH) units remains incompletely explored. In this study, we aim to describe the real-life experience of outpatient remdesivir infusion for COVID-19 in a HaH unit. METHODS We selected all the consecutive patients receiving remdesivir from a prospective cohort of 507 COVID-19 patients admitted at a HaH unit. Admission criteria included COVID-19 with a fraction of inspired oxygen requirement under 0.35 and respiratory rate under 22 rpm. Patients were daily assessed in person by a nurse and a physician. RESULTS A total of 236 patients admitted at the HaH unit received remdesivir, 172 of whom were treated at home. Only 2% presented any adverse event related to the infusion, all of them mild. HaH saved 1416 day-beds, with only 5% of the patients requiring transfer back to the hospital. CONCLUSION Remdesivir infusion in HaH units seems to be a safe and efficient alternative to conventional hospitalization for treating patients with nonsevere COVID-19.
Collapse
Affiliation(s)
- Irene Pereta
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Alma Morancho
- Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Néstor López
- Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Begoña Ibáñez
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina Salas
- Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Laura Moreno
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ariadna Barta
- Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Cubedo
- Genetics, Microbiology and Statistics Department, Statistics Section, Biology Faculty, Universitat de Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Nicole García-Pouton
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Ainoa Ugarte
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Haematology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Verónica Rico
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Laura García
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Altés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain,Corresponding author: Tel: +34-932272030/+34610560336
| |
Collapse
|
15
|
Tan MWJ, Arciga MGA, Arba’in JB, Towle RM, Lim SF, Tang WH, Low LL. Outcomes of a “hospital at home” programme for the supervised home
recovery of COVID-19 patients in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2023; 32:20101058231152049. [PMCID: PMC9845846 DOI: 10.1177/20101058231152049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
Background The Singapore General Hospital COVID-19 Virtual Ward is a “hospital at home” (HaH) programme for the supervised home recovery of higher-acuity COVID-19 patients from the hospital and the community. Objective To describe how an existing HaH programme was redesigned so that COVID-19 patients could be remotely monitored at home and report the outcomes of the first 100 patients in this Virtual Ward. Methods Patients received an admission package comprising instructions and equipment for home monitoring, and uploaded their parameters into a clinical dashboard via a secure messaging app. Medical staff conducted video or telephone consultations daily. Patients were discharged according to time-based criteria, although some required SARS-CoV-2 PCR testing, which were conducted at home by a third-party medical provider. De-identified data of the first 100 patients were analysed by demographic details, indication for enrolment into the Virtual Ward, and the need for subsequent inpatient readmission. Results Of the first 100 patients admitted into the Virtual Ward, 58 were female, mean age was 63.1 years old (23–95 years), and 76 were fully vaccinated. There were 77 hospital referrals and 23 community referrals. The number of days of inpatient hospitalisation avoided was 717 days (average of 7.9 days per patient). Three hospital referrals (3.9%) were readmitted, while seven community referrals (30.4%) required subsequent hospitalisation. Conclusion The Virtual Ward programme demonstrates that selected COVID-19 patient can safely recover at home with remote medical support and monitoring, thereby expanding hospital capacity.
Collapse
Affiliation(s)
- Michelle Woei Jen Tan
- Department of Family Medicine and
Continuing Care, Singapore General
Hospital, Singapore
| | | | - Juweita Binte Arba’in
- Division of Nursing, Singapore General
Hospital, Singapore
- Population Health and Integrated
Care Office, Singapore General
Hospital, Singapore
| | - Rachel Marie Towle
- Division of Nursing, Singapore General
Hospital, Singapore
- Population Health and Integrated
Care Office, Singapore General
Hospital, Singapore
| | - Su-Fee Lim
- Division of Nursing, Singapore General
Hospital, Singapore
- Population Health and Integrated
Care Office, Singapore General
Hospital, Singapore
| | - Woon Hoe Tang
- Population Health and Integrated
Care Office, Singapore General
Hospital, Singapore
| | - Lian Leng Low
- Department of Family Medicine and
Continuing Care, Singapore General
Hospital, Singapore
- Population Health and Integrated
Care Office, Singapore General
Hospital, Singapore
| |
Collapse
|
16
|
Denecke K, May R, Borycki EM, Kushniruk AW. Digital health as an enabler for hospital@home: A rising trend or just a vision? Front Public Health 2023; 11:1137798. [PMID: 36875371 PMCID: PMC9981936 DOI: 10.3389/fpubh.2023.1137798] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background Hospital@home is a model of healthcare, where healthcare professionals actively treat patients in their homes for conditions that may otherwise require hospitalization. Similar models of care have been implemented in jurisdictions around the world over the past few years. However, there are new developments in health informatics including digital health and participatory health informatics that may have an impact on hospital@home approaches. Objectives This study aims to identify the current state of implementation of emerging concepts into the hospital@home research and models of care; to identify strengths and weaknesses, opportunities, and threats associated with the models of care; and to suggest a research agenda. Methods We employed two research methodologies, namely, a literature review and a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The literature from the last 10 years was collected from PubMed using the search string "hospital at home" OR "care at home" OR "patient at home." Relevant information was extracted from the included articles. Results Title and abstract review were conducted on 1,371 articles. The full-text review was conducted on 82 articles. Data were extracted from 42 articles that met our review criteria. Most of the studies originated from the United States and Spain. Several medical conditions were considered. The use of digital tools and technologies was rarely reported. In particular, innovative approaches such as wearables or sensor technologies were rarely used. The current landscape of hospital@home models of care simply delivers hospital care in the patient's home. Tools or approaches from taking a participatory health informatics design approach involving a range of stakeholders (such as patients and their caregivers) were not reported in the literature reviewed. In addition, emerging technologies supporting mobile health applications, wearable technologies, and remote monitoring were rarely discussed. Conclusion There are multiple benefits and opportunities associated with hospital@home implementations. There are also threats and weaknesses associated with the use of this model of care. Some weaknesses could be addressed by using digital health and wearable technologies to support patient monitoring and treatment at home. Employing a participatory health informatics approach to design and implementation could help to ensure the acceptance of such care models.
Collapse
Affiliation(s)
| | - Richard May
- Harz University of Applied Sciences, Wernigerode, Germany
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
17
|
Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
Collapse
|
18
|
Pöyhiä R, Ohvanainen A, Rapo-Pylkkö S, Niemi-Murola L. Influences of COVID-19 pandemic on hospital-at-home functions in Finland - a questionnaire survey. Scand J Prim Health Care 2022; 40:379-384. [PMID: 36325735 PMCID: PMC9848305 DOI: 10.1080/02813432.2022.2139475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate functions of Finnish hospital-at-home (HAH) during the first year of COVID19-pandemic 2020 compared with the previous year 2019. DESIGN Retrospective questionnaire survey. SETTING Finnish HAHs from Northern, Eastern, Southern, Western and Central parts of Finland participated in a questionnaire web-based questionnaire survey. The numbers of patients, activities and staff in 2019 and 2020, participation in the care of COVID19 patients, availability of protective clothing, attitudes of patients towards home care and development of new practices in the corona era were asked using both predefined and free questions. SUBJECTS questionnaire was sent to the nurses and physicians in charge of the HAHs (N = 13), 77% responded. The HAHs provided services to a total of 1,196,783 inhabitants in their municipalities. RESULTS There were no significant changes in the numbers of patients, staff or activities between the years 2019 and 2020. Although nurses did viral tests, COVID19 patients were cared only in 40% of HAHs. Protective clothing was well available. New instructions for infection management were created. CONCLUSIONS The COVID-19 pandemic did not largely influence the functions of the examined Finnish HAHs in 2020. Most activities and patients' characteristics remained unchanged from 2019. The role of HAHs should be further developed in Scandinavian countries, particularly during pandemics.Key PointsHospital-at-home (HAH) is a cost-effective model to provide hospital-like services.Data about the role of HAHs during COVID19 pandemics is lacking in the Nordic countries.This study shows that, the large Finnish municipal HAHs have been not influenced by pandemics.
Collapse
Affiliation(s)
- Reino Pöyhiä
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
- Palliative Medicine, Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Palliative Center, The South Savo Social and Health Care Authority, Mikkeli, Finland
- CONTACT Reino Pöyhiä Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
| | - Antti Ohvanainen
- Palliative Center, Joint Municipal Authority for North Karelia Social and Health Service, Siun sote, Joensuu, Finland
| | | | - Leila Niemi-Murola
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
| |
Collapse
|
19
|
Ko SQ, Goh J, Tay YK, Nashi N, Hooi BMY, Luo N, Kuan WS, Soong JTY, Chan D, Lai YF, Lim YW. Treating acutely ill patients at home: Data from Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:392-399. [PMID: 35906938 DOI: 10.47102/annals-acadmedsg.2021465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes. METHODS We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge. RESULTS A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again. CONCLUSION Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.
Collapse
Affiliation(s)
- Stephanie Q Ko
- Department of Medicine, National University Hospital, Singapore
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Inokuchi R, Jin X, Iwagami M, Sun Y, Sakamoto A, Ishikawa M, Tamiya N. Comparison of the Characteristics and Outcomes of COVID-19 Patients Treated by a Hospital-at-Home Service in Japan during the Alpha and Delta Waves. J Clin Med 2022; 11:jcm11113185. [PMID: 35683569 PMCID: PMC9181747 DOI: 10.3390/jcm11113185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/28/2022] Open
Abstract
Coronavirus infections occurred in repeated waves caused by different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the number of patients increasing during each wave. A private after-hours house-call (AHHC) service provides hospital-at-home (HaH) services to patients in Japan requiring oxygen when hospital beds are in short supply. This retrospective study aimed to compare the characteristics of COVID-19 patients treated by the AHHC service during the COVID-19 waves caused by the Alpha (March−June 2021) and Delta (July−December 2021) SARS-CoV-2 variants. All patients with COVID-19 treated by the AHHC service from March to December 2021 while awaiting hospitalization were included. The data were collected from medical records and follow-up telephone interviews. The AHHC service treated 55 and 273 COVID-19 patients during the Alpha and Delta waves, respectively. The patients treated during the Delta wave were significantly younger than those treated during the Alpha wave (median: 63 years and 47 years, respectively; p < 0.001). Disease severity did not differ significantly between the two waves, but the crude case-fatality rate was significantly higher during the Alpha wave (10/55, 18.2%) than during the Delta wave (4/273, 1.4%; p < 0.001). The patient characteristics and outcomes differed between the Alpha and Delta waves.
Collapse
Affiliation(s)
- Ryota Inokuchi
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Yu Sun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Ayaka Sakamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Masatoshi Ishikawa
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba 305-8577, Ibaraki, Japan
| |
Collapse
|
21
|
Lim A, Hippchen T, Unger I, Heinze O, Welker A, Kräusslich HG, Weigand MA, Merle U. An Outpatient Management Strategy Using a Coronataxi Digital Early Warning System Reduces Coronavirus Disease 2019 Mortality. Open Forum Infect Dis 2022; 9:ofac063. [PMID: 35287336 PMCID: PMC8903386 DOI: 10.1093/ofid/ofac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has caused sudden, severe strain to healthcare systems. Better outpatient management is required to save lives, manage resources effectively, and prepare for future pandemics. Methods The Coronataxi digital early warning (CDEW) system deployed in Rhein-Neckar County and Heidelberg, Germany is an outpatient care system consisting of remote digital monitoring via a mobile application, a medical doctor dashboard, and medical care delivery to COVID-19 patients in home quarantine when indicated. Patients reported their symptoms, temperature, breathing rate, oxygen saturation, and pulse via the app. This single-center cohort study compared outcomes of the population with and without using the CDEW system. The primary outcome was mortality; the secondary outcomes were hospitalization, duration of hospitalization, intensive care therapy, and mechanical ventilation. Results Mortality rate was 3- to 4-fold lower and hospitalization rate was higher in the CDEW cohort (459 patients) compared with the cohort without CDEW in the same test area and other regions (Mannheim, Karlsruhe town, Karlsruhe district, and Germany), (mortality rate: 0.65% [95% confidence interval {CI}, .13%-1.90%] versus 2.16%, 2.32%, 2.48%, 2.82% and 2.76%, respectively, P < .05 for all; hospitalization rate: 14.81% [95% CI, 11.69%-18.40%] versus 6.89%, 6.93%, 6.59%, 6.15%, and 7.22%, respectively, P < .001 for all). The median duration of hospitalization in the CDEW cohort was significantly lower compared with a national sentinel cohort (6 days [interquartile range {IQR}, 4-9.75 days] versus 10 days [IQR, 5-19 days]; Z = -3.156; P = .002). A total of 1.96% patients needed intensive care and 1.09% were mechanically ventilated. Conclusions The CDEW system significantly reduced COVID-19 mortality and duration of hospitalization and can be applied to the management of future pandemics.
Collapse
Affiliation(s)
- Adeline Lim
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Inga Unger
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Heinze
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
22
|
Knight T, Lasserson D. Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population. J Intern Med 2022; 291:438-457. [PMID: 34816527 DOI: 10.1111/joim.13394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recent trends across Europe show a year-on-year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.
Collapse
Affiliation(s)
- Thomas Knight
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Foundation Trust, Birmingham, UK
| | - Daniel Lasserson
- Acute Hospital at Home, Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
23
|
Hospital at Home for Elderly COVID-19 Patients: A Preliminary Report with 100 Patients. J Clin Med 2022; 11:jcm11071850. [PMID: 35407458 PMCID: PMC8999675 DOI: 10.3390/jcm11071850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Hospital-at-home (HaH) care is useful for patients with COVID-19 and an alternative strategy when hospital capacity is under pressure due to patient surges. However, the efficacy and safety of HaH in elderly patients with COVID-19 remain unknown. In Kyoto city, we conducted a retrospective medical record review of HaH care focused on elderly COVID-19 patients from 4 February to 25 June 2021. Eligible patients were (1) COVID-19 patients aged ≥70 years and those who lived with them or (2) COVID-19 patients aged <70 years with special circumstances and those who lived with them. During the study period, 100 patients received HaH care. Their median age was 76 years (interquartile range 56−83), and 65% were over 70 years. Among 100 patients, 36 (36%) had hypoxia (oxygen saturation ≤ 92%), 21 (21%) received steroid medication, and 34 (34%) received intravenous fluids. Although 22 patients were admitted to the hospital and 3 patients died there, no patients died during HaH care. HaH care may be safe and effective in elderly patients with COVID-19. Our study shows that HaH provides an alternative strategy for treating COVID-19 patients and can reduce the healthcare burden at hospitals.
Collapse
|
24
|
Schiff R, Oyston M, Quinn M, Walters S, McEnhill P, Collins M. Hospital at Home: another piece of the armoury against COVID-19. Future Healthc J 2022; 9:90-95. [PMID: 35372768 PMCID: PMC8966799 DOI: 10.7861/fhj.2021-0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Hospital at Home (@Home) services bring the ward to the patient, providing acute care in the home. The @Home team adapted to support the care of patients with COVID-19 in the community who would otherwise have required hospitalisation. Methods An evidence-based guideline and treatment bundle (dexamethasone, oxygen, intravenous fluids and thromboprophylaxis) for managing severe COVID-19 was developed. Data were retrospectively extracted from notes of patients with COVID-19 admitted between 16 December 2020 to 14 February 2021, and service users contacted for feedback. Results One-hundred and twenty-five adults with COVID-19 were treated by @Home; 42 severe (34%) and 83 non-severe (66%) infections; average length of stay was 7 days (interquartile range 4-8). Eight-hundred and seventy-five hospital-occupied bed days were saved. Service users emphasised the importance of being with loved ones and the value of respecting peoples' wishes to be at home. Conclusion @Home gave people with COVID-19 a choice of active treatment at home, thereby extending available healthcare capacity beyond the acute hospital setting.
Collapse
Affiliation(s)
| | - Maria Oyston
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Matthew Quinn
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Paul McEnhill
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Megan Collins
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
25
|
Kamran F, Tang S, Otles E, McEvoy DS, Saleh SN, Gong J, Li BY, Dutta S, Liu X, Medford RJ, Valley TS, West LR, Singh K, Blumberg S, Donnelly JP, Shenoy ES, Ayanian JZ, Nallamothu BK, Sjoding MW, Wiens J. Early identification of patients admitted to hospital for covid-19 at risk of clinical deterioration: model development and multisite external validation study. BMJ 2022; 376:e068576. [PMID: 35177406 PMCID: PMC8850910 DOI: 10.1136/bmj-2021-068576] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To create and validate a simple and transferable machine learning model from electronic health record data to accurately predict clinical deterioration in patients with covid-19 across institutions, through use of a novel paradigm for model development and code sharing. DESIGN Retrospective cohort study. SETTING One US hospital during 2015-21 was used for model training and internal validation. External validation was conducted on patients admitted to hospital with covid-19 at 12 other US medical centers during 2020-21. PARTICIPANTS 33 119 adults (≥18 years) admitted to hospital with respiratory distress or covid-19. MAIN OUTCOME MEASURES An ensemble of linear models was trained on the development cohort to predict a composite outcome of clinical deterioration within the first five days of hospital admission, defined as in-hospital mortality or any of three treatments indicating severe illness: mechanical ventilation, heated high flow nasal cannula, or intravenous vasopressors. The model was based on nine clinical and personal characteristic variables selected from 2686 variables available in the electronic health record. Internal and external validation performance was measured using the area under the receiver operating characteristic curve (AUROC) and the expected calibration error-the difference between predicted risk and actual risk. Potential bed day savings were estimated by calculating how many bed days hospitals could save per patient if low risk patients identified by the model were discharged early. RESULTS 9291 covid-19 related hospital admissions at 13 medical centers were used for model validation, of which 1510 (16.3%) were related to the primary outcome. When the model was applied to the internal validation cohort, it achieved an AUROC of 0.80 (95% confidence interval 0.77 to 0.84) and an expected calibration error of 0.01 (95% confidence interval 0.00 to 0.02). Performance was consistent when validated in the 12 external medical centers (AUROC range 0.77-0.84), across subgroups of sex, age, race, and ethnicity (AUROC range 0.78-0.84), and across quarters (AUROC range 0.73-0.83). Using the model to triage low risk patients could potentially save up to 7.8 bed days per patient resulting from early discharge. CONCLUSION A model to predict clinical deterioration was developed rapidly in response to the covid-19 pandemic at a single hospital, was applied externally without the sharing of data, and performed well across multiple medical centers, patient subgroups, and time periods, showing its potential as a tool for use in optimizing healthcare resources.
Collapse
Affiliation(s)
- Fahad Kamran
- Division of Computer Science and Engineering, University of Michigan College of Engineering, Ann Arbor, MI 48109, USA
- Joint first authors
| | - Shengpu Tang
- Division of Computer Science and Engineering, University of Michigan College of Engineering, Ann Arbor, MI 48109, USA
- Joint first authors
| | - Erkin Otles
- Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor, MI, USA
- Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Dustin S McEvoy
- Mass General Brigham Digital Health eCare, Somerville, MA, USA
| | - Sameh N Saleh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jen Gong
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, CA, USA
| | - Benjamin Y Li
- Division of Computer Science and Engineering, University of Michigan College of Engineering, Ann Arbor, MI 48109, USA
- Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sayon Dutta
- Mass General Brigham Digital Health eCare, Somerville, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Xinran Liu
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Richard J Medford
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas S Valley
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lauren R West
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Karandeep Singh
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seth Blumberg
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - John P Donnelly
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Erica S Shenoy
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael W Sjoding
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Joint senior authors
| | - Jenna Wiens
- Division of Computer Science and Engineering, University of Michigan College of Engineering, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Joint senior authors
| |
Collapse
|
26
|
Chua CMS, Ko SQ, Lai YF, Lim YW, Shorey S. Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis. J Gen Intern Med 2022; 37:637-650. [PMID: 34363185 PMCID: PMC8344392 DOI: 10.1007/s11606-021-07065-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care. METHODOLOGY Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines. RESULTS Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development. CONCLUSION Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.
Collapse
Affiliation(s)
- Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stephanie Qianwen Ko
- Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yi Feng Lai
- Dept of Pharmacy, Alexandra Hospital, National University Health System, Singapore, Singapore
- Dept of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- School of Public Health, University of Illinois at Chicago, Chicago, USA
- MOH Office for Healthcare Transformation, Singapore, Singapore
| | - Yee Wei Lim
- Medical Affairs – Research, Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
27
|
Boone EJ, Shammash JB. Virtual Hospitalization at Home After the Covid-19 Pandemic: Time to Consider Our Future Community Healthcare Options. J Prim Care Community Health 2022; 13:21501319221112586. [PMID: 35838336 PMCID: PMC9289900 DOI: 10.1177/21501319221112586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The concept of acute hospitalization at home has been described for over
3 decades. Its scope, however, was largely limited to small
experimental trials and pilot studies. The Covid-19 pandemic changed
these circumstances. The convergence of the critical need for acute
hospital beds along with the growing sophistication and comfort in
virtual monitoring facilitated the rapid deployment of hospitalization
at home throughout many communities in the United States. Now in the
waning times of the pandemic, community health leaders and health
systems are questioning what the future role of home virtual
hospitalization might be. Might this concept be relegated to only
future times of critical bed shortage, or might it be part of a true
change in community healthcare delivery.
Collapse
Affiliation(s)
- Emily J Boone
- Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | | |
Collapse
|
28
|
Baker E, Facultad JL, Slade H, Lee G. A new tool to measure acuity in the community: a case study. Br J Community Nurs 2021; 26:482-492. [PMID: 34632789 DOI: 10.12968/bjcn.2021.26.10.482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The provision of acute healthcare within patients own home (i.e. hospital in the home) is an important method of providing individualised patient-centred care that reduces the need for acute hospital admissions and enables early hospital discharge for appropriate patient groups. The Hospital in the Home (HitH) model of care ensures that this approach maximises patient safety and limits potential risk for patients. As HitH services have seen record numbers of patient referrals in the past 2 years, there is now a greater need to measure and understand the acuity and dependency levels of the caseload. Through an expert clinician development process at one NHS trust, aspects of procedural complexity, interdisciplinary working, risk stratification and comorbidities were used to quantify acuity and dependency. This paper uses a case study approach to present a new method of measuring this important concept.
Collapse
Affiliation(s)
- Edward Baker
- Lecturer in Applied Technology for Clinical Care, King's College London, King's College Hospital NHS Foundation Trust
| | - Jose Loreto Facultad
- Associate Chief Nurse-Workforce Transformation and Professional Practice, Buckinghamshire Healthcare NHS Trust
| | - Harriet Slade
- Clinical Development Matron, @home service, Guy's and St Thomas' NHS Foundation Trust
| | - Geraldine Lee
- Reader in Applied Technology for Clinical Care, King's College London
| |
Collapse
|
29
|
March-López P, Freixa IA, Gil MM, Espinoza GA, Polonio LO, Paredes EC, Sanchez MC, Sangrador C, Pardo J, Nicolás J, Calbo E. Applicability of Quality Indicators for Appropriate Antibiotic use in Outpatient Parenteral Antimicrobial Therapy (OPAT): A Point Prevalence Survey. Front Pharmacol 2021; 12:713882. [PMID: 34512344 PMCID: PMC8425449 DOI: 10.3389/fphar.2021.713882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to measure the quality of antibiotic prescription is a critical element in any antimicrobial stewardship programme. The aim of this study was to evaluate the clinimetric properties of 33 quality indicators (QIs) developed to assess Outpatient Parenteral Antimicrobial Therapy (OPAT) and to identify potential room for improvement in a hospital-at-home (HaH) unit. Study performed in a healthcare district in Barcelona, Spain with 260,657 inhabitants, nine primary healthcare centres, a 400-bed acute care teaching hospital, and an HaH unit. We studied 33 QIs on appropriate antibiotic use and classified them as qualitative or quantitative. Quantitative QIs were further categorized as measurable or non-measurable depending on the availability of data in the patients’ medical records. Data from 202 OPAT episodes in 192 patients were assessed. Adherence was found for 22 of the 24 qualitative QIs analyzed; the other two showed room for improvement. Four of the nine quantitative indicators were non-measurable. High adherence rates were achieved for QI-17 “The OPAT plan should be documented” (84.65%), QI-26 “The OPAT treatment plan should include choice, dose, frequency, duration and follow-up plan” (79.70%), and QI-33 “The team should document clinical response” (94.55%). Adverse events were documented in just 1.98% of cases (QI-32) and 92.57% patients were classified as alive on discharge (QI-24). The QIs evaluated were applicable to clinical practice and proved useful for identifying areas with room for improvement in our setting and for guiding the design of future interventions with specific objectives.
Collapse
Affiliation(s)
- Pablo March-López
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | - Lidia Ortega Polonio
- Hospital at Home Unit Nurse, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | | | | | - Cristina Sangrador
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Júlia Pardo
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Jordi Nicolás
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Pharmacy Department, Universitat de Barcelona, Barcelona, Spain
| | - Esther Calbo
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| |
Collapse
|
30
|
Abd-Alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review. J Med Internet Res 2021; 23:e29136. [PMID: 34406962 PMCID: PMC8767979 DOI: 10.2196/29136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 06/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. OBJECTIVE This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. METHODS We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. RESULTS Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). CONCLUSIONS Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
Collapse
Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Asmaa Hassan
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Israa Abuelezz
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Arfan Ahmed
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Mahmood Saleh Alzubaidi
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Uzair Shah
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Anna Giannicchi
- School of Professional Studies, Berkeley College, New York, NY, United States
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| |
Collapse
|
31
|
Martínez-Roca A, Rodríguez-Lobato LG, Ballestar N, Gallego C, Fernández-Avilés F. Personalized at-home autologous hematopoietic stem cell transplantation during the SARS-CoV-2 outbreak. Leuk Res 2021; 106:106589. [PMID: 33971562 PMCID: PMC8064822 DOI: 10.1016/j.leukres.2021.106589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Martínez-Roca
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain.
| | - Luis Gerardo Rodríguez-Lobato
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Ballestar
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Cristina Gallego
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Francesc Fernández-Avilés
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
32
|
Casafont C, Fabrellas N, Rivera P, Olivé-Ferrer MC, Querol E, Venturas M, Prats J, Cuzco C, Frías CE, Pérez-Ortega S, Zabalegui A. Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study. NURSE EDUCATION TODAY 2021; 97:104711. [PMID: 33418340 PMCID: PMC7744273 DOI: 10.1016/j.nedt.2020.104711] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has caused a worldwide health and social crisis directly impacting the healthcare system. Hospitals had to rearrange its structure to meet clinical needs. Spain has been experiencing a shortage of working nurses. Student nurses in their last year at university were employed to help the National Health System respond to the COVID-19 crisis. AIM The aim of this study was to explore and understand the experience of nursing students' roles as healthcare aid in responding to the COVID-19 crisis. METHODS A qualitative phenomenology design was used to explore undergraduate nursing students' perceptions of their experiences as HAs during the COVID-19 outbreak. Open face-to-face interviews were conducted to nursing students (n = 10) in May 2020. Data was analyzed using the hermeneutic interpretative approach. RESULTS All participants were women aged between 21 and 25 years. Seven main themes emerged: learning, ambivalent emotions and adaptation were classified at a personal level; teamwork, patient communication, and unclear care processes were categorized under hospital structure; and coping mechanisms were part of external factors. CONCLUSIONS Orientation, follow-up, and emotional support in crisis situations are key to unexperienced healthcare workers overcoming stressful emotions. Previous academic education and training may help novice future nurses feel more confident about their tasks and responsibilities as well as improve patient outcomes, resource management, and staff safety.
Collapse
Affiliation(s)
- Claudia Casafont
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain
| | - Núria Fabrellas
- University of Barcelona (Campus Clinic Nursing School), Spain
| | | | | | | | - Montserrat Venturas
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain
| | | | - Cecilia Cuzco
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain
| | - Cindy E Frías
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain
| | - Silvia Pérez-Ortega
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain
| | - Adelaida Zabalegui
- Hospital Clinic of Barcelona, Spain; University of Barcelona (Campus Clinic Nursing School), Spain.
| |
Collapse
|
33
|
Coloma E, Nicolás D. Hospital at Home units in the post-COVID 19 era. Eur J Clin Invest 2020; 50:e13390. [PMID: 32852794 PMCID: PMC7460947 DOI: 10.1111/eci.13390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Emmanuel Coloma
- Hospital at Home Unit, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain.,Internal Medicine Service, Hospital Clinic, Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain.,Internal Medicine Service, Hospital Clinic, Barcelona, Spain
| |
Collapse
|