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Hernandez C, Herranz C, Baltaxe E, Seijas N, González-Colom R, Asenjo M, Coloma E, Fernandez J, Vela E, Carot-Sans G, Cano I, Roca J, Nicolas D. The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service. Cost Eff Resour Alloc 2024; 22:30. [PMID: 38622593 PMCID: PMC11017527 DOI: 10.1186/s12962-024-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). METHODS A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017-2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. RESULTS HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs. 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). CONCLUSIONS The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. REGISTRATION ClinicalTrials.gov (26/04/2017; NCT03130283).
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Affiliation(s)
- Carme Hernandez
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Carme Herranz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Consorci d'Atenció Primària de Salut de l'Eixample (CAPSBE), Barcelona, Spain
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Nuria Seijas
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
| | - Rubèn González-Colom
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Maria Asenjo
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Fernandez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Emili Vela
- Àrea de Sistemes d'Informació. Servei Català de la Salut, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Catalan Health Service, Barcelona, Spain
| | - Gerard Carot-Sans
- Àrea de Sistemes d'Informació. Servei Català de la Salut, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Catalan Health Service, Barcelona, Spain
| | - Isaac Cano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Roca
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Nicolas
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
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Shi C, Dumville J, Rubinstein F, Norman G, Ullah A, Bashir S, Bower P, Vardy ERLC. Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components. BMC Med 2024; 22:145. [PMID: 38561754 PMCID: PMC10986022 DOI: 10.1186/s12916-024-03312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Technology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence of effectiveness to explore implications for practice and research. METHODS For this review (registered here https://osf.io/je39y ), we searched Cochrane-recommended multiple databases up to 30 November 2022 and additional resources for randomised and non-randomised studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. We classified interventions into care model groups using three key components: clinical activities, workforce, and technology. We synthesised evidence by these groups quantitatively or narratively for mortality, hospital readmissions, cost-effectiveness and length of stay. RESULTS We include 69 studies: 38 randomised studies (6413 participants; largely judged as low or unclear risk of bias) and 31 non-randomised studies (31,950 participants; largely judged at serious or critical risk of bias). The 69 studies described 63 interventions which formed eight model groups. Most models, regardless of using low- or high-intensity technology, may have similar or reduced hospital readmission risk compared with hospital-based inpatient care (low-certainty evidence from randomised trials). For mortality, most models had uncertain or unavailable evidence. Two exceptions were low technology-enabled models that involve hospital- and community-based professionals, they may have similar mortality risk compared with hospital-based inpatient care (low- or moderate-certainty evidence from randomised trials). Cost-effectiveness evidence is unavailable for high technology-enabled models, but sparse evidence suggests the low technology-enabled multidisciplinary care delivered by hospital-based teams appears more cost-effective than hospital-based care for those with chronic obstructive pulmonary disease (COPD) exacerbations. CONCLUSIONS Low-certainty evidence suggests that none of technology-enabled care at home models we explored put people at higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models. It is unclear whether inpatient-level care at home using higher levels of technology confers additional benefits. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation. TRIAL REGISTRATION https://osf.io/je39y .
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Affiliation(s)
- Chunhu Shi
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK.
| | - Jo Dumville
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
| | - Fernando Rubinstein
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Gill Norman
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Akbar Ullah
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Saima Bashir
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Emma R L C Vardy
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
- Oldham Care Organisation, Northern Care Alliance NHS Foundation Trust, Oldham, UK
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O'Neil B, Dindinger-Hill K, Gill H, Coombs L, Haaland B, Ying J, Nelson RE, McPherson J, Kirchhoff AC, Ulrich CM, Huber J, Beck A, Mooney K. Cost and Utilization Outcomes in Huntsman at Home, a Novel Oncology Hospital at Home Program. J Am Med Dir Assoc 2024; 25:610-613. [PMID: 37541650 DOI: 10.1016/j.jamda.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES In a real-world trial, we previously demonstrated that Huntsman at Home, a novel oncology hospital at home program, was associated with reduced health care utilization and costs. In this study, we sought to understand the impact of Huntsman at Home in specific patient subgroups defined by sex, age, area-level median income, Charlson Comorbidity Index, and current use of systemic anticancer therapy. DESIGN Retrospective case-control study of the Huntsman Cancer Institute. Electronic Data Warehouse of patients enrolled in Huntsman at Home between August 2018 through October 2019 vs usual-care patients. SETTING AND PARTICIPANTS A total of 169 patients admitted to Huntsman at Home compared with 198 usual-care patients. METHODS Five dichotomous subgroups evaluated including sex (female vs male), age (≥65 vs <65), income (≥$78,735 vs <$78,735), Charlson Comorbidity Index (≥2 vs <2), and current systemic anticancer therapy use vs no current systemic anticancer therapy. Groups were compared with patients receiving usual care. Primary outcomes included 30-day costs, hospital length of stay, unplanned hospitalizations, and emergency room visits. RESULTS Admission to Huntsman at Home was associated with an overall reduction across all 4 health care cost and utilization outcomes. Outcomes favoring admission to Huntsman at Home achieved statistical significance (P < .05) in at least 2 of the 4 outcomes for each subgroup studied. Of the subgroups that did not achieve statistically significant benefit from Huntsman at Home admission in some outcome categories, none of these subgroups favored usual care. CONCLUSIONS AND IMPLICATIONS Admission to Huntsman at Home decreased utilization of unplanned health care and reduced costs across a wide spectrum of patient subgroups, suggesting overall consistent benefit from the service. Hospital at home models should be considered as a means by which the quality and efficiency of care can be maximized for patients with cancer.
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Affiliation(s)
- Brock O'Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | | | - Hailie Gill
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lorinda Coombs
- School of Nursing, University of North Carolina, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jian Ying
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Richard E Nelson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jordan McPherson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jared Huber
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Beck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Kathi Mooney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Kahn-Boesel O, Mitchell H, Li L, Zhu E, El-Jawahri A, Levine D, Ufere NN. Hospital-Level Care at Home for Patients with Cirrhosis. Dig Dis Sci 2024:10.1007/s10620-024-08361-5. [PMID: 38466464 DOI: 10.1007/s10620-024-08361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients. AIMS The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality. METHODS We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up. RESULTS 22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7 days (IQR 4-12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30 days. CONCLUSIONS In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.
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Affiliation(s)
| | - Henry Mitchell
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucinda Li
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA
| | - Ennie Zhu
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - David Levine
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA.
- Liver Center, Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Chen H, Ignatowicz A, Skrybant M, Lasserson D. An integrated understanding of the impact of hospital at home: a mixed-methods study to articulate and test a programme theory. BMC Health Serv Res 2024; 24:163. [PMID: 38308304 PMCID: PMC10835828 DOI: 10.1186/s12913-024-10619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Hospital at Home (HaH) provides intensive, hospital-level care in patients' homes for acute conditions that would normally require hospitalisation, using multidisciplinary teams. As a programme of complex medical-social interventions, a HaH programme theory has not been fully articulated although implicit in the structures, functions, and activities of the existing HaH services. We aimed to unearth the tacit theory from international evidence and test the soundness of it by studying UK HaH services. METHODS We conducted a literature review (29 articles) adopting a 'realist review' approach (theory articulation) and examined 11 UK-based services by interviewing up to 3 staff members from each service (theory testing). The review and interview data were analysed using Framework Analysis and Purposive Text Analysis. RESULTS The programme theory has three components- the organisational, utilisation and impact theories. The impact theory consists of key assumptions about the change processes brought about by HaH's activities and functions, as detailed in the organisational and utilisation theories. HaH teams should encompass multiple disciplines to deliver comprehensive assessments and have skill sets for physically delivering hospital-level processes of care in the home. They should aim to treat a broad range of conditions in patients who are clinically complex and felt to be vulnerable to hospital acquired harms. Services should cover 7 days a week, have plans for 24/7 response and deliver relational continuity of care through consistent staffing. As a result, patients' and carers' knowledge, skills, and confidence in disease management and self-care should be strengthened with a sense of safety during HaH treatment, and carers better supported to fulfil their role with minimal added care burden. CONCLUSIONS There are organisational factors for HaH services and healthcare processes that contribute to better experience of care and outcomes for patients. HaH services should deliver care using hospital level processes through teams that have a focus on holistic and individually tailored care with continuity of therapeutic relationships between professionals and patients and carers resulting in less complexity and fragmentation of care. This analysis informs how HaH services can organise resources and design processes of care to optimise patient satisfaction and outcomes.
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Affiliation(s)
- Hong Chen
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK
| | - Agnieszka Ignatowicz
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TTT, UK
| | - Magdalena Skrybant
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TTT, UK
| | - Daniel Lasserson
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK.
- Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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González-Colom R, Carot-Sans G, Vela E, Espallargues M, Hernández C, Jiménez FX, Nicolás D, Suárez M, Torné E, Villegas-Bruguera E, Ozores F, Cano I, Piera-Jiménez J, Roca J. Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance. BMC Health Serv Res 2024; 24:154. [PMID: 38297234 PMCID: PMC10832077 DOI: 10.1186/s12913-024-10603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Hospital at home (HaH) was increasingly implemented in Catalonia (7.7 M citizens, Spain) achieving regional adoption within the 2011-2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015-2019) in a consolidated regional program and provide context-independent recommendations for continuous quality improvement of the service. METHODS A mixed-methods approach was adopted, combining population-based retrospective analyses of registry information with qualitative research. HaH (admission avoidance modality) was compared with a conventional hospitalization group using propensity score matching techniques. We evaluated the 12-month period before the admission, the hospitalization, and use of healthcare resources at 30 days after discharge. A panel of experts discussed the results and provided recommendations for monitoring HaH services. RESULTS The adoption of HaH steadily increased from 5,185 episodes/year in 2015 to 8,086 episodes/year in 2019 (total episodes 31,901; mean age 73 (SD 17) years; 79% high-risk patients. Mortality rates were similar between HaH and conventional hospitalization within the episode [76 (0.31%) vs. 112 (0.45%)] and at 30-days after discharge [973(3.94%) vs. 1112(3.24%)]. Likewise, the rates of hospital re-admissions at 30 days after discharge were also similar between groups: 2,00 (8.08%) vs. 1,63 (6.58%)] or ER visits [4,11 (16.62%) vs. 3,97 (16.03%). The 27 hospitals assessed showed high variability in patients' age, multimorbidity, severity of episodes, recurrences, and length of stay of HaH episodes. Recommendations aiming at enhancing service delivery were produced. CONCLUSIONS Besides confirming safety and value generation of HaH for selected patients, we found that this service is delivered in a case-mix of different scenarios, encouraging hospital-profiled monitoring of the service.
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Affiliation(s)
- Rubèn González-Colom
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain.
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare (DS3) - IDIBELL, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare (DS3) - IDIBELL, Barcelona, Spain
| | - Mireia Espallargues
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Carme Hernández
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | | | - David Nicolás
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | | | | | | | - Fernando Ozores
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Isaac Cano
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare (DS3) - IDIBELL, Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Josep Roca
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
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Levine AA, Shin MH, Adjognon OL, Engle RL, Sullivan JL. Overcoming barriers to implementation: mapping implementation strategies in four hospital in home programs within the Veterans Health Administration. Home Health Care Serv Q 2024:1-18. [PMID: 38174378 DOI: 10.1080/01621424.2023.2301413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013. We utilized qualitative directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR) and mapped identified barriers to possible strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. We identified 11 barriers spanning 5 CFIR domains. Three implementation strategies - identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge - achieved high expert endorsement for each barrier. A mix of strategies targeting resources, organizational readiness and fit, and leadership engagement should be considered to support the sustainability and spread of HIH.
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Affiliation(s)
- A Alex Levine
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Omonyele L Adjognon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Ryann L Engle
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Jennifer L Sullivan
- COIN LTSS, Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, West Roxbury, Massachusetts, USA
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Dumkow LE, Geyer AC, Davidson LE. Antimicrobial Stewardship at Transitions of Care. Infect Dis Clin North Am 2023; 37:769-791. [PMID: 37580244 DOI: 10.1016/j.idc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Antimicrobial stewardship interventions have historically been siloed in different care settings; recently, a need for stewardship interventions at care transitions has arisen as inappropriate prescribing at care transitions may result in patient harm. There are several care areas that should be considered for optimizing antibiotic prescribing. Interventions can be difficult to implement as they often require the efforts of a multidisciplinary team and are resource intensive. Antimicrobial stewardship programs should prioritize interventions at transitions of care to improve prescribing and patient outcomes.
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Affiliation(s)
- Lisa E Dumkow
- Trinity Health Grand Rapids, 200 Jefferson Avenue, Grand Rapids, MI 49503, USA.
| | - Abigail C Geyer
- Trinity Health Grand Rapids, 200 Jefferson Avenue, Grand Rapids, MI 49503, USA
| | - Lisa E Davidson
- Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA; Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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10
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Goggins S. The importance of a comprehensive geriatric assessment for older people admitted onto a virtual ward. Br J Nurs 2023; 32:882-889. [PMID: 37830865 DOI: 10.12968/bjon.2023.32.18.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
A comprehensive geriatric assessment (CGA) provides a holistic assessment for the frail and older person. The CGA considers physical and mental conditions as well as function, environmental and a person's social circumstances. Virtual wards are a new concept within the NHS, and use of virtual wards during the COVID-19 pandemic reduced hospital admissions by 50%. The British Geriatrics Society has set clear guidelines on how virtual wards should be developed within integrated care services via multidisciplinary community rapid response teams to improve patient outcomes. This article considers a logical approach to assessing suitability for admission onto a virtual ward for a patient who required hospital-at-home services. It does this through the use of a theoretical patient case study, in this case involving delirium and urinary tract infection. Frailty and frailty scoring tools are discussed, as are the advantages and disadvantages of a CGA, considering a clear progression through the five domains. It shows how conducting a CGA allows for the development of a problem list to help prioritise the patient's problems and plan accordingly. A critical review of the literature around virtual wards, hospital-at-home services and admission avoidance identified that community rapid response teams were the logical choice to provide a multidisciplinary holistic approach to the older person admitted onto a virtual ward.
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Affiliation(s)
- Suzanne Goggins
- Consultant Practitioner, Northern Care Alliance NHS Foundation Trust/Bury Local Care Organisation, Bury
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11
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Castillo BA, Shterenberg R, Bolton JM, Dewa CS, Pullia K, Hensel JM. Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. Psychiatr Serv 2023; 74:1045-1051. [PMID: 37016824 DOI: 10.1176/appi.ps.20220332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The COVID-19 pandemic motivated rapid expansion of virtual care. In Winnipeg, Canada, the authors launched a virtual psychiatric acute care ward (vWARD) to divert patients from hospitalization through daily remote treatment by a psychiatry team using telephone or videoconferencing. This study examined vWARD patient characteristics, predictors of transfer to a hospital, use of acute care postdischarge, and costs of the vWARD compared with in-person hospitalization. METHODS Data for all vWARD admissions from March 23, 2020, to April 30, 2021, were retrieved from program documents and electronic records. Emergency department visits and hospitalizations in the 6 months before admission and the 30 days after discharge were documented. Logistic regression identified factors associated with transfer to a hospital. Thirty-day acute care use after discharge was modeled with Kaplan-Meier curves. A break-even cost analysis was generated with data for usual hospital-based care. RESULTS The 132 vWARD admissions represented a diverse demographic and clinical population. Overall, 57% involved suicidal behavior, and 29% involved psychosis or mania. Seventeen admissions (13%) were transferred to a hospital. Only presence of psychosis or mania significantly predicted transfer (OR=34.2, 95% CI=3.3-354.6). Eight individuals were hospitalized in the 30 days postdischarge (cumulative survival=0.93). vWARD costs were lower than usual care across several scenarios. CONCLUSIONS A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization. It has benefits for both the health system and the individual who prefers to receive care at home.
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Affiliation(s)
- Bon A Castillo
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Ravit Shterenberg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Carolyn S Dewa
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Katrina Pullia
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Jennifer M Hensel
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
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12
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Dubois-Silva Á, Otero-Plaza L, Dopico-Santamariña L, Mozo-Ríos A, Hermida-Porto L, Feal-Cortizas B, García-Queiruga M, Pértega-Díaz S, Lamelo-Alfonsín F, Vidán-Martínez L. Outpatient parenteral antimicrobial therapy with continuous infusion of meropenem: A retrospective analysis of three years of clinical experience. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:321-328. [PMID: 36610829 DOI: 10.1016/j.eimce.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/03/2021] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Data regarding outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion of meropenem (CIM) remain scarce and controversial. We aimed to analyze its outcomes. METHODS We conducted a retrospective analysis of a cohort of patients who received OPAT with CIM during a three-year period at a single center in northwest Spain. Demographics, clinical data and OPAT outcomes were recorded. RESULTS Since January 2017-December 2019, 34 patients received 35 OPAT episodes with CIM. The median age was 75 years, and 18 (51.4%) had a Charlson comorbidity index>2. Twelve (34.3%) had respiratory infection, 11 (31.4%) urinary tract infection, and 12 (34.3%) other infections. Twenty-one (60%) received a dose of 6g/day, and 27 (77.1%) received combined antibiotic therapy. The duration of OPAT with CIM was 10 median days. Pseudomonas aeruginosa was the most frequently (34.3%) isolated microorganism and 10 (28.6%) infections were polymicrobial. During OPAT and hospital at home unit admission, 4 (11.4%) patients had any adverse reaction that required CIM withdrawal, 2 (5.7%) were readmitted, and 3 (8.8%) died (2 infection-related deaths). After 30 days from discharge 6 (18.8%) of 32 not-censored patients had unplanned readmissions (2 infection-related), 6 (18.8%) developed recurrence (3 relapses, 3 reinfections) and 1 (3.1%) died (none-infection-related death). Twenty-three (71.9%) of these 32 patients did not experience unplanned readmission, recurrence or death. CONCLUSION CIM can be an option to be administrated in OPAT programs in selected patients. Further studies are warranted to increase evidence regarding its use, and to externally validate our findings.
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Affiliation(s)
- Álvaro Dubois-Silva
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain.
| | - Lara Otero-Plaza
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Leticia Dopico-Santamariña
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain
| | - Ana Mozo-Ríos
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Leticia Hermida-Porto
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Begoña Feal-Cortizas
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Marta García-Queiruga
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Sonia Pértega-Díaz
- Universidade da Coruña (UDC), A Coruña, Spain; Research Support Unit, Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Fernando Lamelo-Alfonsín
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
| | - Luciano Vidán-Martínez
- Hospital at Home Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain
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13
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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 DOI: 10.1186/s12913-023-09531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
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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
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Mirón-Rubio M, Parra Jordán JJ, González Ramallo VJ, Mujal Martínez A, Fernández Muixí J, Iglesias Gallego M, Lucas Núñez MC, Rodado Alabau E, Vidal Perez-Campoamor S, Uría E. Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT). Rev Esp Quimioter 2023; 36:291-301. [PMID: 37017118 DOI: 10.37201/req/134.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. METHODS Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. RESULTS We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was €7,326 (95% confidence interval: €6,316-€8,416). CONCLUSIONS Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission.
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Affiliation(s)
- M Mirón-Rubio
- Manuel Mirón Rubio, Hospital Universitario de Torrejón, C. Mateo Inurria, s/n, 28850 Torrejón de Ardoz, Madrid, Spain.
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15
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Paulson MR, Shulman EP, Dunn AN, Fazio JR, Habermann EB, Matcha GV, McCoy RG, Pagan RJ, Maniaci MJ. Implementation of a virtual and in-person hybrid hospital-at-home model in two geographically separate regions utilizing a single command center: a descriptive cohort study. BMC Health Serv Res 2023; 23:139. [PMID: 36759867 PMCID: PMC9911182 DOI: 10.1186/s12913-023-09144-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As providers look to scale high-acuity care in the patient home setting, hospital-at-home is becoming more prevalent. The traditional model of hospital-at-home usually relies on care delivery by in-home providers, caring for patients in urban communities through academic medical centers. Our objective is to describe the process and outcomes of Mayo Clinic's Advanced Care at Home (ACH) program, a hybrid virtual and in-person hospital-at-home model combining a single, virtual provider-staffed command center with a vendor-mediated in-person medical supply chain to simultaneously deliver care to patients living near an urban hospital-at-home command center and patients living in a rural region in a different US state and time zone. METHODS A descriptive, retrospective medical records review of all patients admitted to ACH between July 6, 2020, and December 31, 2021. Patients were admitted to ACH from an urban academic medical center in Florida and a rural community hospital in Wisconsin. We collected patient volumes, age, sex, race, ethnicity, insurance type, primary hospital diagnosis, 30-day mortality rate, in-program mortality, 30-day readmission rate, rate of return to hospital during acute phase, All Patient Refined-Diagnosis Related Groups (APR-DRG) Severity of Illness (SOI), and length of stay (LOS) in both the inpatient-equivalent acute phase and post-acute equivalent restorative phase. RESULTS Six hundred and eighty-six patients were admitted to the ACH program, 408 in Florida and 278 in Wisconsin. The most common diagnosis seen were infectious pneumonia (27.0%), septicemia / bacteremia (11.5%), congestive heart failure exacerbation (11.5%), and skin and soft tissue infections (6.3%). Median LOS in the acute phase was 3 days (IQR 2-5) and median stay in the restorative phase was 22 days (IQR 11-26). In-program mortality rate was 0% and 30-day mortality was 0.6%. The mean APR-DRG SOI was 2.9 (SD 0.79) and the 30-day readmission rate was 9.7%. CONCLUSIONS The ACH hospital-at-home model was able to provide both high-acuity inpatient-level care and post-acute care to patients in their homes through a single command center to patients in urban and rural settings in two different geographical locations with favorable outcomes of low mortality and hospital readmissions.
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Affiliation(s)
- Margaret R. Paulson
- grid.414713.40000 0004 0444 0900Division of Hospital Internal Medicine, Mayo Clinic Health System, Menomonie, WI USA
| | | | - Ajani N. Dunn
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Jacey R. Fazio
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Elizabeth B. Habermann
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA
| | - Gautam V. Matcha
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Rozalina G. McCoy
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDivision of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN USA
| | - Ricardo J. Pagan
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Michael J. Maniaci
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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17
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Kanagala SG, Gupta V, Kumawat S, Anamika FNU, McGillen B, Jain R. Hospital at home: emergence of a high-value model of care delivery. Egypt J Intern Med 2023; 35:21. [PMID: 36969500 PMCID: PMC10023005 DOI: 10.1186/s43162-023-00206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/12/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND With increasing healthcare demands for acute illness in patients especially in the times of pandemic, healthcare organizations require modern solutions. Hospital at home (HaH) is one such tool that has the potential to solve these problems without compromising the care of the patients. MAIN BODY Hospitals have been the conventional setting for managing acute sickness patients; however, it could be a very challenging environment for a few patients, especially for the older population who are highly susceptible to hospital-acquired infections. Health care in a hospital setting can also be very expensive, as it often involves a lot of healthcare professionals providing care. HaH service can provide the same quality of care expected in traditional settings. CONCLUSIONS The median length of stay and the rate of readmissions were lower in people under HaH care. Compared with patients in a hospital setting, patients in HaH had better clinical outcomes. HaH unit provides an integrated, flexible, easy-to-scale platform that can be cost-effectively adapted to high-demand situations.
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Affiliation(s)
| | - Vasu Gupta
- grid.413495.e0000 0004 1767 3121Dayanand Medical College and Hospital, Ludhiana, India
| | - Sunita Kumawat
- grid.496644.d0000 0004 1772 4558Index Medical College Hospital & Research Center, Indore, India
| | - FNU Anamika
- grid.412444.30000 0004 1806 781XUniversity College of Medical Sciences, Delhi, India
| | - Brian McGillen
- grid.240473.60000 0004 0543 9901Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
| | - Rohit Jain
- grid.240473.60000 0004 0543 9901Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
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18
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Inzitari M, Arnal C, Ribera A, Hendry A, Cesari M, Roca S, Pérez LM. Comprehensive Geriatric Hospital at Home: Adaptation to Referral and Case-Mix Changes During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:3-9.e1. [PMID: 36470320 PMCID: PMC9647017 DOI: 10.1016/j.jamda.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the evolution of a Hospital at Home (HAH) based on comprehensive geriatric assessment (CGA), including its adaptability to changing case-mixes and pathways during the COVID-19 pandemic. DESIGN Observational study of consecutive admissions to a combined step-up (admissions from home) and step-down (hospital discharge) HAH during 3 periods: prepandemic (2018‒February 2020) vs pandemic (March‒December 2020, and January‒December 2021). SETTING AND PARTICIPANTS Participants were all consecutive patients admitted to a CGA-based HAH, located in Barcelona, Spain. Referrals followed acute events or exacerbation of chronic conditions, by either primary care (step-up) or after post-acute discharge (step-down). METHODS HAH intervention based on CGA and incorporated geriatric rehabilitation. Patient case-mix, functional evolution (Barthel index), and mortality were compared across periods and between pathways. RESULTS HAH capacity expanded 3 fold from 15 to 45 virtual beds and altogether managed 688 consecutive patients [mean age (SD) = 82.5 (9.6) years; 59% women]. Pandemic case-mix was slightly older (mean age = 83.5 vs 82 years, P = .012) than prepandemic, with greater mobility impairment. Across periods, step-up increased (26.1%, 40.9%, 48.2%, P < .01) because of medical events, skin ulcers, and post-acute stroke, whereas step-down decreased; multivariable models showed no differences in functional improvement or mortality. When comparing pathways, step-up featured older patients with higher comorbidity, worse functional status, and lower absolute functional gain than step-down (5.6 vs 13 points of Barthel index, P < .01), remaining statistically significant after adjusting for covariates (P = .003); no differences in mortality were observed. CONCLUSIONS AND IMPLICATIONS A multipurpose, step-down and step-up CGA HAH expanded its activity and adapted to changing case-mixes and pathways throughout COVID-19 pandemic waves. Although further quantitative and qualitative studies are needed to assess the impact of this model, our results suggest that harnessing the adaptability of HAH may help advance a paradigm shift toward more person-centered, cost-effective models of clinical care aimed at older adults.
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Affiliation(s)
- Marco Inzitari
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain.
| | - Cristina Arnal
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Aida Ribera
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Anne Hendry
- School of Health and Life Sciences, University of the West of Scotland, Scotland, United Kingdom
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Sílvia Roca
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain
| | - Laura Mónica Pérez
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain
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19
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Vrotsou K, Orive-Calzada M, González N, Vergara I, Pascual-Fernández N, Guerra-López C, García-Montes R, Ortiz-Ribes J, Onaindia-Ecenarro MJ, Regalado-de Los Cobos J, Millet-Sampedro M. [Factors associated with the hospital at home workload: A Delphi consensus study]. J Healthc Qual Res 2022:S2603-6479(22)00075-6. [PMID: 36272932 DOI: 10.1016/j.jhqr.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/20/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To identify and prioritize a list of factors that contribute to the workload of the hospital at home (HaH) professionals. MATERIAL AND METHODS A qualitative methodology study performed between January and December 2019 in the 10 HAH units of the Basque Country. The data were obtained in 4phases: 1. Systematic literature search and review; 2. Expert group meeting; 3. Consensus method: Delphi technique (2 survey rounds) and nominal group meeting; 4. Meeting of the research team. RESULTS In the systematic literature search and review 85 factors were initially identified. These were reduced to 38 after the 8-person expert group meeting, in which 10 new factors were added. After the 2 Delphi rounds (106 and 57 professionals, respectively), 17 factors were maintained and 12 remained in doubt. The latter were evaluated at the nominal group meeting, consisting of 13 professionals who decided to eliminate 5 factors, include 3, and keep 3 as doubt. After the 8-person research team meeting, 14 potential factors were finally selected. They are related to the place of residence, the health state and social situation of the patients, as well as the health care provided at home. CONCLUSIONS The identified factors could serve for improving the organization and optimize the daily word of the HaH professionals.
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Affiliation(s)
- K Vrotsou
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Guipúzcoa, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España.
| | - M Orive-Calzada
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Departamento de Psicología Social, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, Araba, España
| | - N González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, España; Osakidetza, Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - I Vergara
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Guipúzcoa, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - N Pascual-Fernández
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Bidasoa, Hondarribia, Gipuzkoa, España
| | - C Guerra-López
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Bidasoa, Hondarribia, Gipuzkoa, España
| | - R García-Montes
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, España
| | - J Ortiz-Ribes
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, España
| | - M J Onaindia-Ecenarro
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - J Regalado-de Los Cobos
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Universitario de Araba, Vitoria-Gasteiz, Araba, España
| | - M Millet-Sampedro
- Osakidetza, Unidad de Hospitalización a Domicilio, Hospital Bidasoa, Hondarribia, Gipuzkoa, España
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20
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Coquery SS, Georges A, Cortey A, Floch C, Avran D, Gatbois E, Mehler-Jacob C, de Stampa M. Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy. Eur J Pediatr 2022; 181:3075-3084. [PMID: 35695955 DOI: 10.1007/s00431-022-04461-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique-Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5 days. Two patients needed readmission in conventional hospital (1%) for less than 24 h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home. Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care. What is Known: • Managing neonatal jaundice is provided in conventional hospital with phototherapy. • Neonatal jaundice increases the risk of prolonged hospitalization or readmission. What is New: • Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia. • The care pathway of neonates from conventional hospital to hospital at home is described.
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Affiliation(s)
- Sarah Spyridakis Coquery
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Alexandre Georges
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Anne Cortey
- Assistance Publique Hôpitaux de Paris (AP-HP), Centre National de Référence en Hémobiologie Périnatale (CNRHP), 26 avenue du Dr Arnold-Netter, 75571, Paris, France
| | - Corinne Floch
- Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - David Avran
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Edith Gatbois
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Claire Mehler-Jacob
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Matthieu de Stampa
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France. .,Unité Mixte de Recherche (UMR), UVSQ, 1018 INSERM, Paris, France.
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21
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Yao X, Paulson M, Maniaci MJ, Dunn AN, Nelson CR, Behnken EM, Hart MS, Sangaralingham LR, Inselman SA, Lampman MA, Dunlay SM, Dowdy SC, Habermann EB. Effect of hospital-at-home vs. traditional brick-and-mortar hospital care in acutely ill adults: study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:503. [PMID: 35710450 PMCID: PMC9201794 DOI: 10.1186/s13063-022-06430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivering acute hospital care to patients at home might reduce costs and improve patient experience. Mayo Clinic's Advanced Care at Home (ACH) program is a novel virtual hybrid model of "Hospital at Home." This pragmatic randomized controlled non-inferiority trial aims to compare two acute care delivery models: ACH vs. traditional brick-and-mortar hospital care in acutely ill patients. METHODS We aim to enroll 360 acutely ill adult patients (≥18 years) who are admitted to three hospitals in Arizona, Florida, and Wisconsin, two of which are academic medical centers and one is a community-based practice. The eligibility criteria will follow what is used in routine practice determined by local clinical teams, including clinical stability, social stability, health insurance plans, and zip codes. Patients will be randomized 1:1 to ACH or traditional inpatient care, stratified by site. The primary outcome is a composite outcome of all-cause mortality and 30-day readmission. Secondary outcomes include individual outcomes in the composite endpoint, fall with injury, medication errors, emergency room visit, transfer to intensive care unit (ICU), cost, the number of days alive out of hospital, and patient-reported quality of life. A mixed-methods study will be conducted with patients, clinicians, and other staff to investigate their experience. DISCUSSION The pragmatic trial will examine a novel virtual hybrid model for delivering high-acuity medical care at home. The findings will inform patient selection and future large-scale implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT05212077. Registered on 27 January 2022.
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Affiliation(s)
- Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Margaret Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ajani N Dunn
- Administrative Operations, Mayo Clinic, Jacksonville, FL, USA
| | - Chad R Nelson
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Melissa S Hart
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shealeigh A Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michelle A Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shannon M Dunlay
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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22
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Leff B, DeCherrie LV, Montalto M, Levine DM. A research agenda for hospital at home. J Am Geriatr Soc 2022; 70:1060-1069. [PMID: 35211969 PMCID: PMC9303641 DOI: 10.1111/jgs.17715] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. METHODS Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. RESULTS 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. CONCLUSIONS While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.
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Affiliation(s)
- Bruce Leff
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linda V DeCherrie
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Montalto
- Hospital in the Home Unit, Epworth Hospital, Melbourne, Victoria, Australia
| | - David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA
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23
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Mittaine-Marzac B, De Stampa M, Marquestaut O, Georges A, Ankri J, Aegerter P. Treatment for multiple myeloma in hospital at home: clinical characteristics and patient care pathways. Home Health Care Serv Q 2022; 41:165-181. [PMID: 34979881 DOI: 10.1080/01621424.2021.2023063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While most patients receive anticancer injection in a conventional hospital, some are treated in hospital at home. Given the lack of data, we seek to determine the clinical characteristics and care pathways of patients benefiting from hospital at home (HAH) for anticancer injection. A longitudinal scheme was conducted about patients with multiple myeloma (MM) starting bortezomib-based regimens in HAH in 2015 with a follow-up to September 2019. 154 patients received bortezomib at home with a mean age of 70.6 years, 72.7% over 65y-old and, a median Karnofsky Performans Status of 70. One-third of the elderly lived alone, 16.1% required domestic help. After a 24-month follow-up, 77.9% of patients were alive. The median overall survival was not reached at 4 years. Between 42.1% and 48.1% of patients returned to HAH for a new line of treatment. Patients were mainly independent and "fit." The involvement of HAH was achieved without safety issues nor compromise long-term outcomes. However, the real-world patterns highlighted that only a small proportion of patients returned to HAH for a new treatment line.
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Affiliation(s)
- Bénédicte Mittaine-Marzac
- Hospitalisation À Domicile Assistance Publique Des Hôpitaux de Paris, Paris, France.,Cesp - Centre de Recherche En Epidémiologie Et Santé Des Populations - U1018 Inserm Ups Université Paris-Saclay, Uvsq, Hôpital Paul Brousse Villejuif Cedex Université Versailles St-Quentin, Villejuif Cedex, France
| | - Matthieu De Stampa
- Hospitalisation À Domicile Assistance Publique Des Hôpitaux de Paris, Paris, France.,Cesp - Centre de Recherche En Epidémiologie Et Santé Des Populations - U1018 Inserm Ups Université Paris-Saclay, Uvsq, Hôpital Paul Brousse Villejuif Cedex Université Versailles St-Quentin, Villejuif Cedex, France
| | - Odile Marquestaut
- Hospitalisation À Domicile Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Alexandre Georges
- Hospitalisation À Domicile Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Joel Ankri
- Cesp - Centre de Recherche En Epidémiologie Et Santé Des Populations - U1018 Inserm Ups Université Paris-Saclay, Uvsq, Hôpital Paul Brousse Villejuif Cedex Université Versailles St-Quentin, Villejuif Cedex, France
| | - Philippe Aegerter
- Cesp - Centre de Recherche En Epidémiologie Et Santé Des Populations - U1018 Inserm Ups Université Paris-Saclay, Uvsq, Hôpital Paul Brousse Villejuif Cedex Université Versailles St-Quentin, Villejuif Cedex, France
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24
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van Ramshorst J, Duffels M, de Boer SPM, Bos-Schaap A, Drexhage O, Walburg S, de Beij J, van der Stoop D, Umans VAWM. Connected care for endocarditis and heart failure patients: a hospital-at-home programme. Neth Heart J 2021; 30:319-327. [PMID: 34524621 PMCID: PMC9123121 DOI: 10.1007/s12471-021-01614-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.
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Affiliation(s)
- J van Ramshorst
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Duffels
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - S P M de Boer
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - A Bos-Schaap
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - O Drexhage
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | | | | | - D van der Stoop
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - V A W M Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
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25
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Scherrenberg M, Storms V, van der Velde AE, Boyne J, Bruins W, Vranken J, Leenen JPL, Brunner-La Rocca HP, De Kluiver EP, Dendale P. A Home Hospitalisation Strategy for Patients with an Acute Episode of Heart Failure Using a Digital Health-Supported Platform: A Multicentre Feasibility Study - A Rationale and Study Design. Cardiology 2021; 146:793-800. [PMID: 34438396 DOI: 10.1159/000519085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart failure (HF) is a common cause of hospitalisation and mortality in elderly. The frequent rehospitalisations put a serious burden on patients, health-care budgets, and health-care capacity. Frequent hospital admissions are also associated with a substantial additional hazard for serious complications and reduced quality of life. The NWE-Chance project will explore the feasibility and scalability of providing home hospitalisation supported by a newly developed digital health-supported platform and daily visits of specialised nurses. METHODS/DESIGN Hundred patients with chronic HF will be recruited over a 1-year period. The digital health-supported home hospitalisation strategy will be tested in 3 hospitals with different experience in delivering home hospitalisation: Isala Zwolle, Maastricht UMC+, both in The Netherlands, and Jessa Hospital, Hasselt in Belgium. The home hospitalisation intervention will have a maximal duration of 14 days. Feasibility will be measured with acceptability, satisfaction, and usability questionnaires for patients, nurses, and physicians. Furthermore, safety and costs will be assessed for 30 days after the start of the home hospitalisation intervention. DISCUSSION The NWE-Chance project will be one of the first studies to examine the feasibility of a digital health-supported home hospitalisation platform for HF patients. It has the potential to augment current standard HF care and quality of life of HF patients and to innovate the standard HF care to potentially lower the hospitalisation-related complications, the burden of HF on health-care systems, and to potentially implement more patient-centred care strategies.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium, .,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium, .,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium,
| | - Valerie Storms
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Josiane Boyne
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Julie Vranken
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jobbe P L Leenen
- Isala Heart Centre, Zwolle, The Netherlands.,Connected Care Center, Isala, Zwolle, The Netherlands
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Marinello R, Brunetti E, Luppi C, Bianca D, Tibaldi V, Isaia G, Bo M. Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home. Aging Clin Exp Res 2021; 33:1753-1756. [PMID: 34003476 PMCID: PMC8129597 DOI: 10.1007/s40520-021-01875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
Hospital at Home (HaH) has been proposed as a solution to relieve pressure on hospital beds during the COVID-19 pandemic; however, caregivers' feelings of inadequacy and concerns on the need for tighter clinical monitoring might lead to unnecessary and potentially harmful hospital admissions in frail older patients with mild or atypical COVID-19. Here we report the case of a 91-year old woman with severe dementia and atypical COVID-19 that could be successfully managed by our HaH thanks to her highly motivated caregivers and the support of a telemedicine solution (TMS) to provide caregiver training and support as well as supplementary telemonitoring. Despite some well-known issues on TMS use, the hybrid in-person and tele-visit approach of TMS-assisted HaH could help to create a "secure" environment, empowering caregivers to manage frail older adults with COVID-19 at home, avoiding unnecessary admissions to closed wards and their negative physical, functional and psychological outcomes.
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Affiliation(s)
- Renata Marinello
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - Enrico Brunetti
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy.
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy.
| | - Chiara Luppi
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - Dario Bianca
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Vittoria Tibaldi
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - Gianluca Isaia
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - Mario Bo
- Hospital at Home Service, Section of Geriatrics, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
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Scott J, Abaraogu UO, Ellis G, Giné-Garriga M, Skelton DA. A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field. Eur Geriatr Med 2021; 12:227-238. [PMID: 33058019 PMCID: PMC7557152 DOI: 10.1007/s41999-020-00414-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this review was to identify, evaluate and synthesise existing evidence reporting the physical activity levels of acutely ill older patients in a 'Hospital At Home' setting and compare this to patients with similar characteristics treated in a traditional hospital inpatient setting. Functional changes and any adverse outcomes due to physical activity (e.g. falls) in both settings where PA was reported or recorded were also evaluated as secondary outcomes. METHODS A search strategy was devised for the MEDLINE, CINAHL, AMed, PEDRO, OT Seeker and Cochrane databases. Search results were title, abstract and full-text reviewed by two independent researchers. Data were extracted from included articles using a custom form and assessed for quality and risk of bias using the Appraisal Tool for Cross-Sectional Studies. RESULTS No studies set in the Hospital at Home environments were identified. 16 hospital inpatient studies met the criteria for inclusion. Older patients managed in inpatient settings that would be eligible for Hospital at Home services spent 6.6% of their day active and undertook only 881.8 daily steps. Functional change was reported in four studies with both improvement and decline during admission reported. CONCLUSION There is a lack of published research on the physical activity levels of acutely-ill older adults in Hospital at Home settings. This review has identified a baseline level of activity for older acutely ill patients that would be suitable for Hospital at Home treatment. This data could be used as a basis of comparison in future hospital at home studies, which should also include functional change outcomes to further explore the relationship between physical inactivity and functional decline.
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Affiliation(s)
- Jennifer Scott
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Ukachukwu O Abaraogu
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria
| | - Graham Ellis
- NHS Lanarkshire, Monklands Hospital, Monkscourt Ave, Airdrie, UK
| | - Maria Giné-Garriga
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Ariza Jiménez AB, Madrid Rodríguez A, Peláez Cantero MJ, Caro Aguilera P, Pérez Frias FJ, Pérez-Ruiz E. [Patient with respiratory compromise controlled by a pediatric home hospitalization unit.]. Rev Esp Salud Publica 2021; 95:e202103039. [PMID: 33720113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The use of paediatric home oxygen therapy is initiated in neonatal chronic lung disease; later it spreads to other patients with chronic hypoxemia. The frequency and need for oxygen therapy is growing; this, together with the family benefits, justify the implementation of a home treatment plan. Our objective with this work was to know and describe the characteristics of the patients admitted to the Pediatric HaD Unit of a tertiary hospital, the average cost per patient of oxygen therapy during 13 years of review, and evaluate the quality of the service. METHODS Retrospective descriptive study by reviewing records of patients admitted to home care hospital at home of a paediatric tertiary care hospital (n=124) for 13 years (2000-2013), to learn and to describe the characteristics of the unit and these patients, and costs. After that, it was done statistical analysis through t-Student. RESULTS 124 patients with chronic hypoxemia patients with mean age of 2.2 years. The most frequent cause was lung diseases, including ECPN as the most important. They accounted 14.2% of hospitalizations in home care hospital at home department, and 60% were achieved clinical stability. The mean cost was 1,991.1€ per patient, which supposes 93% of economical saving in comparison with conventional hospitalization (3,988.91€). CONCLUSIONS The use of oxygen in HaD improves the quality of life and survival of our patients, reducing the number of readmissions and hospital costs.
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Affiliation(s)
- Ana Belén Ariza Jiménez
- Unidad de Gestión Clínica de Pediatría. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
| | - Aurora Madrid Rodríguez
- Hospitalización a Domicilio Pediátrica, Unidad de Gestión Clínica de Pediatría. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
| | - María José Peláez Cantero
- Hospitalización a Domicilio Pediátrica, Unidad de Gestión Clínica de Pediatría. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
| | - Pilar Caro Aguilera
- Neumología Infantil. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
| | - Francisco Javier Pérez Frias
- Neumología Infantil. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
- Universidad de Málaga. Málaga. España
| | - Estela Pérez-Ruiz
- Neumología Infantil. Hospital Regional Universitario de Málaga (Materno-Infantil). Málaga. España
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Hecimovic A, Matijasevic V, Frost SA. Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney. BMC Health Serv Res 2020; 20:1090. [PMID: 33243232 PMCID: PMC7690027 DOI: 10.1186/s12913-020-05941-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background Hospital at home (HaH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HaH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HaH care across the South Western Sydney Local Health District (SWSLHD) has not been well described. This project aimed to describe the characteristics and outcomes of HaH services across the SWSLHD. Methods The characteristics of patients referred to HaH between January 2017 and December 2019, the indications for HaH, and representation rates to hospital emergency department (ED) will be presented. Results Between January 2017 and December 2019 there was 7118 referrals to the local health district’s (LHD) HaH services, among 6083 patients (3094 females, 51%), median age 56 years (Interquartile range (IQR), 40–69). The majority of indications for HaH were for intravenous venous (IV) medications (78%, n = 5552), followed by post-operative drain management (11%, n = 789), rehab in the home (RiTH) (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HaH only occurred on 172 (2%) of occasions. The average length of HaH treatment was 7-days (IQR 4–16). Rates of presentation to ED for HaH patients have decreased since 2017, 3.4% (95% CI 2.7–4.2%), 2018 2.1% (95% CI 1.5–2.8%), and 2019 1.8% (95% CI 1.3–2.4%), p-value for trend < 0.001. Conclusion Hospital at Home is well established, diverse, and safe clinical service to shorten, or avoid hospitalisation, for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.
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Affiliation(s)
- Anthony Hecimovic
- Rosemeadow Community Health Centre, Sydney, Australia.,Primary and Community Health South Western Sydney Local Health District, Sydney, Australia.,South Western Sydney Local Health District Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Western Sydney University, 1-3 Campbell street Liverpool, Sydney, 2170, Australia
| | - Vesna Matijasevic
- Rosemeadow Community Health Centre, Sydney, Australia.,Primary and Community Health South Western Sydney Local Health District, Sydney, Australia.,South Western Sydney Local Health District Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Western Sydney University, 1-3 Campbell street Liverpool, Sydney, 2170, Australia
| | - Steven A Frost
- South Western Sydney Local Health District Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Western Sydney University, 1-3 Campbell street Liverpool, Sydney, 2170, Australia. .,Liverpool Hospital, Sydney, Australia.
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30
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Pericàs JM, Cucchiari D, Torrallardona-Murphy O, Calvo J, Serralabós J, Alvés E, Agelet A, Hidalgo J, Alves E, Castells E, Seijas N, Hernández C, Bodro M, Cardozo C, Coloma E, Nicolás D. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. Infection 2020; 49:327-332. [PMID: 32995970 PMCID: PMC7523688 DOI: 10.1007/s15010-020-01527-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Alternatives to conventional hospitalization are needed to increase health systems resilience in the face of COVID-19 pandemic. Herein, we describe the characteristics and outcomes of 63 patients admitted to a single HaH during the peak of COVID-19 in Barcelona. Our results suggest that HaH seems to be a safe and efficacious alternative to conventional hospitalization for accurately selected patients with COVID-19.
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Affiliation(s)
- Juan M Pericàs
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain. .,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain. .,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain. .,Vall D'Hebron Institute for Research (VHIR), Barcelona, Spain.
| | - David Cucchiari
- Renal Transplantation Service, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Júlia Calvo
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain
| | - Júlia Serralabós
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisenda Alvés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Aleix Agelet
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Judit Hidalgo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eduarda Alves
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - David Nicolás
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Rossinot H, Marquestaut O, de Stampa M. The experience of patients and family caregivers during hospital-at-home in France. BMC Health Serv Res 2019; 19:470. [PMID: 31288804 DOI: 10.1186/s12913-019-4295-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient’s home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH. Methods The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals’ HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory. Results HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH’s organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself. Conclusion HAH strongly involved the patient’s caregiver(s) all along the process. HAH’s development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home. Electronic supplementary material The online version of this article (10.1186/s12913-019-4295-7) contains supplementary material, which is available to authorized users.
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Abstract
PURPOSE OF REVIEW Over recent years, there has been a marked increase in the number of centres delivering paediatric outpatient parenteral antimicrobial therapy (pOPAT). Various factors have fuelled this drive, including the significant economic pressures faced by high-income countries to contain the cost of healthcare, resulting in a significant reduction of in-patient beds over the past 20 years. It is essential that pOPAT services have formal clinical governance structures in place to ensure the safe and effective management of children being ambulated on intravenous antibiotics. They also require oversight of antimicrobial decisions by a medically qualified infection specialist to ensure that the principles of antimicrobial stewardship are adhered to. This review aims to provide an evidence-based framework for delivering pOPAT services. RECENT FINDINGS There is increasing data supporting the implementation of admission avoidance strategies for children with cellulitis and pyelonephritis. In addition, recent data supports the management of a subset of children with febrile neutropenia within pOPAT services. Above all, there is a clear recognition that embedding antimicrobial stewardship within pOPAT services reduces duration of intravenous antibiotics (IVAbs) and improves patient management. pOPAT services are safe, cost-effective and associated with high levels of parent/patient satisfaction. Further research is required to develop risk prediction models for children being considered for pOPAT. Further data about the use of elastomeric devices in children and the acceptability of parental administration of IVAbs are also required.
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Affiliation(s)
- Sanjay Patel
- Department of Paediatric Infectious Diseases & Immunology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Mailpoint 43, Tremona Road, Southampton, SO16 6YD, UK. .,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Helen Green
- Department of Paediatric Infectious Diseases & Immunology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Mailpoint 43, Tremona Road, Southampton, SO16 6YD, UK
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Mäkelä P, Godfrey M, Cradduck-Bamford A, Ellis G, Shepperd S. A protocol for the process evaluation of a multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials 2018; 19:569. [PMID: 30340618 PMCID: PMC6194629 DOI: 10.1186/s13063-018-2929-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attempts to design services to support the delivery of healthcare closer to home have taken various forms as countries respond to an increase in hospital admission rates for older people, who are at risk of hospital-acquired morbidity, prolonged lengths of stay and readmission. Evidence to support the development of these services is limited. We are conducting a process evaluation, alongside a UK multi-site randomised trial, to understand the contexts and practices of implementing geriatrician-led admission avoidance hospital at home services and to explore ways that the intervention might be effective, under what conditions, for whom, and how it differs from inpatient care. METHODS We are interviewing patients and their caregivers, from sites that are purposively sampled from participating National Health Service (NHS) trusts across the UK. We are also visiting sites to observe local processes and discuss the establishment and running of services with a range of multidisciplinary staff, managers, commissioners, primary care and social services representatives. We aim to interview approximately 36 patients and their caregivers with experience of hospital at home or inpatient services; 12 at each of three sites. We will use a content analysis approach to explore data across participants, services and sites. DISCUSSION This process evaluation will enable evaluation of implementation processes prior to knowing trial outcomes. We encompass domains of reach, delivery, change, context and response to the intervention by patients, their carers, health professionals and the health system. TRIAL REGISTRATION ISRCTN60477865 . Registered on 10 March 2014. Trial sponsor: University of Oxford. Version 3.1, registered on 14 June 2016.
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Affiliation(s)
- Petra Mäkelä
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Mary Godfrey
- Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ UK
| | - Andrea Cradduck-Bamford
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Graham Ellis
- Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Pearson M, Hemsley A, Blackwell R, Pegg L, Custerson L. Improving Hospital at Home for frail older people: insights from a quality improvement project to achieve change across regional health and social care sectors. BMC Health Serv Res 2017; 17:387. [PMID: 28583180 PMCID: PMC5460362 DOI: 10.1186/s12913-017-2334-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/25/2017] [Indexed: 11/16/2022] Open
Abstract
Background Against a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs. Improving patient outcomes requires change across hospital and community systems. Our objective was to change practice in order to deliver a Hospital at Home programme (admission avoidance and early supported discharge) for frail older people across a regional commissioning area. The programme, undertaken within the Northern, Eastern & Western Devon Clinical Commissioning Group (CCG) sub-localities of Exeter (population 120,000) and Woodbury, Exmouth and Budleigh Salterton (towns with populations of around 10,000), involved reconfiguration of existing services rather than being a stand-alone intervention. Methods Quality Improvement methodology, with hospital and community staff using Plan-Do-Study-Act (PDSA) cycles to implement and test service changes. Outcome measures: 1) Discharge destination; 2) Length of stay; 3) Acute Community Team referrals. Results Against a backdrop of intense financial pressures, significant community bed closures, and difficult relations between hospital and community services, outcomes remained stable (discharge destination, length of hospital stay, and number of referrals to the community team). Conclusion PDSA cycles enabled stakeholders across acute and community services to be involved, promoted a process of collaborative inquiry and ownership of findings, and improved motivation to act on results and produce change. Practitioners and managers seeking to improve the delivery of complex, cross-cutting services in other areas can learn from the experience of applying Quality Improvement methods reported here. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2334-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Pearson
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC, South West Peninsula, Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - A Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - R Blackwell
- South West Academic Health Science Network (SW AHSN), Pynes Hill Court, Pynes Hill, Exeter, EX2 5SP, UK
| | - L Pegg
- Newton Abbot Hospital, West Golds Road, Jetty Marsh, Newton Abbot, Devon, TQ12 2TS, UK
| | - L Custerson
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
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González-Ramallo VJ, Mirón-Rubio M, Mujal A, Estrada O, Forné C, Aragón B, Rivera AJ. Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain. Int J Antimicrob Agents 2017; 50:114-118. [PMID: 28499957 DOI: 10.1016/j.ijantimicag.2017.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain.
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Affiliation(s)
- V J González-Ramallo
- Hospital at Home Unit, Department of Internal Medicine, Gregorio Marañón Hospital, Madrid, Spain.
| | - M Mirón-Rubio
- Hospital at Home Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - A Mujal
- Hospital at Home Unit, Department of Internal Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - O Estrada
- Northern Metropolitan Area, Catalan Health Institute (ICS), Badalona, Barcelona, Spain
| | - C Forné
- Department of Health Economics and Outcomes Research, Oblikue Consulting, Barcelona, Spain
| | - B Aragón
- Merck Sharp & Dohme Corp., Madrid, Spain
| | - A J Rivera
- Merck Sharp & Dohme Corp., Madrid, Spain
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Ravelingien T, Buyle F, Deryckere S, Sermijn E, Debrauwere M, Verplancke K, Callens S, Commeyne S, Pattyn C, Vogelaers D. Optimization of a model of out-of-hospital antibiotic therapy (OPAT) in a Belgian university hospital resulting in a proposal for national implementation. Acta Clin Belg 2016; 71:297-302. [PMID: 27203290 DOI: 10.1080/17843286.2016.1183285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Some infections require prolonged parenteral antimicrobial therapy, which can be continued in an outpatient setting. The Ghent University Hospital has 15 years of experience with Outpatient Parenteral Antimicrobial Therapy (OPAT) in the home setting of the patient. METHODS Multidisciplinary critical approach through identification of areas for improvement with the existing OPAT process within the Ghent University Hospital. Existing literature and guidelines were used as references. An improved model is proposed for implementation. RESULTS Several challenges and barriers were identified, including regulatory obstacles for OPAT in Belgium, such as lack of uniformity in ambulatory reimbursement of parenteral antimicrobials. There is no financial incentive for the patient with OPAT, as costs for the patient of outpatient therapy can be higher as compared with hospitalization. Other barriers include delayed approval of the certificate for reimbursement, low availability of medicines in the community pharmacies and limited knowledge of the medical devices for administration in ambulatory setting. All critical steps in the revised OPAT program are summarized in a flowchart with a checklist for all stakeholders. Firstly, a list with specific criteria to include patients in an OPAT program is provided. Secondly, the Multidisciplinary Infection Team received a formal mandate to review all eligible OPAT patients. In order to select the most appropriate catheter, a decision tree was developed and standardized packages with medical devices were developed. Thirdly, patients receive oral and written information about the treatment with practical and financial implications. Fourthly, information is provided toward the general practitioners, community pharmacist and home care nurse. CONCLUSION Standardization of the OPAT program aims at improving quality and safety of intravenous antimicrobial therapy in the home setting.
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Abstract
Outpatient parenteral antimicrobial therapy (OPAT) refers to the administration of a parenteral antimicrobial in a non inpatient or ambulatory setting with the explicit aim of facilitating admission avoidance or early discharge. Whilst OPAT has predominantly been the domain of the infection specialist, the internal medicine specialist has a key role in service development and delivery as a component of broader ambulatory care initiatives such as "hospital at home". Main drivers for OPAT are patient welfare, reduction of risk of health care associated infection and cost-effective use of hospital resources. The safe practice of OPAT is dependent on a team approach with careful patient selection and antimicrobial management with programmed and adaptable clinical monitoring and assessment of outcome. Gram-positive infections, including cellulitis, bone and joint infection, bacteraemia and endocarditis are key infections potentially amenable to OPAT whilst resistant Gram-negative infections are of increasing importance. Ceftriaxone, teicoplanin, daptomycin and ertapenem lend themselves well to OPAT due to daily (or less frequent) bolus administration, although any antimicrobial may be administered if the patient is trained to administer and/or an appropriate infusion device is employed. Clinical experience from NHS Greater Glasgow and Clyde is presented to illustrate the key principles of OPAT as practised in the UK. Increasingly complex patients with multiple medical needs, the relative scarcity of inpatient resources and the broader challenge of ambulatory care and "hospital at home" will ensure the internal medicine specialist will have a key role in the future development of OPAT.
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Affiliation(s)
- R A Seaton
- Brownlee Centre for Infectious Diseases, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom.
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