Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment

OBJECTIVE: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. METHODS: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic pati...

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Autores: Hernández, Carme, Aibar Gallizo, Jesús, Seijas, Nuria, Puig, Imma, Alonso, Albert, García Aymerich, Judith, Roca Torrent, Josep
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/156460
Acceso en línea:https://hdl.handle.net/2445/156460
Access Level:acceso abierto
Palabra clave:Malalts crònics
Atenció domiciliària
Salut pública
Chronically ill
Home care services
Public health
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spelling Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessmentHernández, CarmeAibar Gallizo, JesúsSeijas, NuriaPuig, ImmaAlonso, AlbertGarcía Aymerich, JudithRoca Torrent, JosepMalalts crònicsAtenció domiciliàriaSalut públicaChronically illHome care servicesPublic healthOBJECTIVE: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. METHODS: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients' and professionals' perspectives, technologies and costs were evaluated. RESULTS: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0-3) days and the length of home-based stay was 6 (5-7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918 per patient discharged, significantly lower than conventional hospitalization (2,879 ) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. CONCLUSIONS: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.Universiteit Utrecht2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/156460Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.5334/ijic.3431International Journal of Integrated Care, 2018, vol. 18, num. 2, p. 12https://doi.org/10.5334/ijic.3431info:eu-repo/grantAgreement/EC/H2020/689802cc-by (c) Hernández, Carme et al., 2018http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1564602026-05-27T06:46:51Z
dc.title.none.fl_str_mv Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
title Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
spellingShingle Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
Hernández, Carme
Malalts crònics
Atenció domiciliària
Salut pública
Chronically ill
Home care services
Public health
title_short Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
title_full Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
title_fullStr Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
title_full_unstemmed Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
title_sort Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
dc.creator.none.fl_str_mv Hernández, Carme
Aibar Gallizo, Jesús
Seijas, Nuria
Puig, Imma
Alonso, Albert
García Aymerich, Judith
Roca Torrent, Josep
author Hernández, Carme
author_facet Hernández, Carme
Aibar Gallizo, Jesús
Seijas, Nuria
Puig, Imma
Alonso, Albert
García Aymerich, Judith
Roca Torrent, Josep
author_role author
author2 Aibar Gallizo, Jesús
Seijas, Nuria
Puig, Imma
Alonso, Albert
García Aymerich, Judith
Roca Torrent, Josep
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Malalts crònics
Atenció domiciliària
Salut pública
Chronically ill
Home care services
Public health
topic Malalts crònics
Atenció domiciliària
Salut pública
Chronically ill
Home care services
Public health
description OBJECTIVE: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. METHODS: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients' and professionals' perspectives, technologies and costs were evaluated. RESULTS: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0-3) days and the length of home-based stay was 6 (5-7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918 per patient discharged, significantly lower than conventional hospitalization (2,879 ) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. CONCLUSIONS: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/156460
url https://hdl.handle.net/2445/156460
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.5334/ijic.3431
International Journal of Integrated Care, 2018, vol. 18, num. 2, p. 12
https://doi.org/10.5334/ijic.3431
info:eu-repo/grantAgreement/EC/H2020/689802
dc.rights.none.fl_str_mv cc-by (c) Hernández, Carme et al., 2018
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Hernández, Carme et al., 2018
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universiteit Utrecht
publisher.none.fl_str_mv Universiteit Utrecht
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.300724

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