Hospital at home - a review of our experience

Preference of primary care patients for home-based healthcare and support services: a discrete choice experiment in China

Importance

This research, utilizing discrete choice experiments, examines the preferences and willingness to pay for home-based healthcare and support services among residents in China, a country grappling with severe aging population, an area often underexplored in international scholarship.

Objectives

This study aims to solicit the preferences of primary care patients for home-based healthcare and support services in China.

Design setting and participants

A discrete choice experiment (DCE) was conducted on 312 primary care patients recruited from 13 community health centers in Wuhan and Kunming between January and May 2023. The experimental choice sets were generated using NGene, covering five attributes: Scope of services, health professionals, institutions, insurance reimbursements, and visiting fees.

Main outcomes and measures

The choice sets were further divided into three blocks, and each participant was asked to complete one block containing 12 choice tasks. Mixed logit models were established to estimate the relevant importance coefficients of and willingness to pay for different choices, while Latent Class Logit (LCL) modeling was conducted to capture possible preferences heterogeneity.

Results

The relevant importance of the scope of services reached 67.33%, compared with 19.84% for service institutions and 12.42% for health professionals. Overall, respondents preferred physician-led diagnostic and treatment services. LCL categorized the respondents into three groups: Group one (60.20%) was most concerned about the scope of services, prioritizing disease diagnosis and treatment over preventive care and mental health, while group two (16.60%) was most concerned about care providers (hospitals and medical doctors were preferred), and group three (23.20%) was most concerned about financial burdens.

Conclusion

Primary care patients prefer physical health and medical interventions for home-based healthcare and support services. However, heterogeneity in preferences is evident, indicating potential disparities in healthcare and support at home services in China.

Mobile care - a possible future for emergency care in Sweden

INTRODUCTION

Provision of mobile care at the home of patients appears to become necessary as the population becomes increasingly older. But there are challenges in moving emergency care from hospitals to the home of patients. The aim of the study was therefore to describe the experiences of the mobile care in Sweden.

METHOD

Semi structured interviews were conducted with 12 persons with experience of mobile care in Sweden, such as nurses, physicians, civil servants and politicians. Qualitative latent content analysis was used as an analysis method.

RESULT

The results show that cooperation is of utmost importance to achieve functioning mobile care. Cooperation both on an inter-organizational level and on a close team-work is required for all of the involved parties in mobile care to take on a joint responsibility for the patient. As mobile care is primarily provided to elderly multimorbid patients, a comprehensive view on patient care is required in which the patient and their relatives experience security.

CONCLUSION

Mobile care is seen as a moving care that comes to the seeking person and not the other way around. The resources are distributed where they make the most use, that is, closest to the individual. Mobile care is seen as a complement to the traditional hospital care. This means a different way of working that requires close collaboration between different categories of personnel and organizations, where there should not be any discussions about boundaries, rather, the discussion should include patient's needs and situation instead.

Digital health as an enabler for hospital@home: A rising trend or just a vision?

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.

The efficacy of intravenous tranexamic acid administration at induction in definitive hip fracture surgery: Is there a role?

Tranexamic acid (TXA) is a cheap and powerful drug that has several uses in surgery and is well established in elective orthopaedic surgery. At present, limited small studies have looked into its role in the acute hip fracture. Transfusion in the geriatric population presents risks and increased costs to healthcare systems around the world. Our retrospective study looks at the role of TXA administration at induction for both intracapsular fracture requiring hemiarthroplasty and our preferred method of fixation of extracapsular fracture by intramedullary nail (IM nail). We show a statistically significant reduction in the number of patients requiring transfusion as well as mean haemoglobin (Hb) drop in those undergoing hemiarthroplasty. This was not replicated in those undergoing IM nail fixation. Both groups showed no increase in 1-year mortality or thromboembolic events following TXA administration. These results support the use of TXA for hemiarthroplasty for intracapsular hip fractures over the age of 60.

OBJECTIVES

The aim of this pre and post interventional study looks at the effects of intravenous administration of tranexamic acid on induction for elderly patients undergoing hemiarthroplasty or intramedullary nail fixation for hip fractures.

DESIGN

Pre and post interventional, randomised observational study SETTING: Large hip fracture unit, Level 2 Trauma Centre, single centre PATIENTS: Two arms of the study looking at those aged above the age of 60 undergoing hemiarthroplasty and intramedullary nail fixation without and with tranexamic acid on induction.

RESULTS

12.1% of hemiarthroplasties required post-operative transfusion without tranexamic acid compared to 2.6% of those with tranexamic acid (n=15 vs n=3 respectively, p=0.006). Equally, the mean Hb drop in g/L is reduced in those with tranexamic acid compared to those without (mean Hb = 14.6 vs 17.7 respectively, p=0.034). This was not replicated in the IM nail group between those without and those with tranexamic acid (n=31 vs n=20 respectively, p= 0.16). The mean Hb drop in g/L was not statistically significant in the tranexamic acid arm compared to without (mean Hb = 19.2 vs mean Hb = 21.9, p=0.11). Gross reporting of thromboembolic events did not demonstrate an increase in the number of those with DVT, PE, MI or stroke. 1-year mortality was not statistically significant in either hemiarthroplasty or IM nail fixation following tranexamic acid administration.

CONCLUSIONS

Tranexamic acid both statistically significantly reduces the number of patients requiring transfusion post hemiarthroplasty and also the value of mean Hb drop without appearing to increase in thromboembolic events or 1 year mortality rates. This does not appear to be emulated in the IM nail fixation although both thrombotic events and 1-year mortality rates are also not affected by administration of TXA. We propose that TXA has a role in hemiarthroplasty surgery in reducing post-operative transfusions.

LEVEL OF EVIDENCE

Level 3 - retrospective cohort study.