Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care

Objective To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Design Quasi-experimental longitudinal study. Setting An acute care hospital, an intermediate care hospital, and the community of an ur...

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Autores: Closa, Conxita, Mas, Miquel, Santaeugènia Gonzàlez, Sebastià J, Inzitari, Marco, Ribera, Aida, Gallofré Ocaña, Marc
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Universitat Oberta de Catalunya (UOC)
Repositorio:O2, repositorio institucional de la UOC
OAI Identifier:oai:openaccess.uoc.edu:10609/150697
Acceso en línea:http://hdl.handle.net/10609/150697
https://doi.org/10.1016/j.jamda.2017.04.006
Access Level:acceso embargado
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spelling Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based CareClosa, ConxitaMas, MiquelSantaeugènia Gonzàlez, Sebastià JInzitari, MarcoRibera, AidaGallofré Ocaña, MarcObjective To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Design Quasi-experimental longitudinal study. Setting An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. Participants In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Intervention Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. Measurements We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. Results No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P < .001. Length of acute hospital stay was significantly shorter in patients discharged to home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P < .001]. Conclusion The hospital-at-home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs.Elsevier202420242017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10609/150697https://doi.org/10.1016/j.jamda.2017.04.006reponame:O2, repositorio institucional de la UOCinstname:Universitat Oberta de Catalunya (UOC)InglésJournal of the American Medical Directors Association, 2017, 18(9)https://doi.org/10.1016/j.jamda.2017.04.006© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicineinfo:eu-repo/semantics/embargoedAccessoai:openaccess.uoc.edu:10609/1506972026-05-28T12:42:01Z
dc.title.none.fl_str_mv Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
title Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
spellingShingle Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
Closa, Conxita
title_short Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
title_full Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
title_fullStr Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
title_full_unstemmed Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
title_sort Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care
dc.creator.none.fl_str_mv Closa, Conxita
Mas, Miquel
Santaeugènia Gonzàlez, Sebastià J
Inzitari, Marco
Ribera, Aida
Gallofré Ocaña, Marc
author Closa, Conxita
author_facet Closa, Conxita
Mas, Miquel
Santaeugènia Gonzàlez, Sebastià J
Inzitari, Marco
Ribera, Aida
Gallofré Ocaña, Marc
author_role author
author2 Mas, Miquel
Santaeugènia Gonzàlez, Sebastià J
Inzitari, Marco
Ribera, Aida
Gallofré Ocaña, Marc
author2_role author
author
author
author
author
description Objective To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Design Quasi-experimental longitudinal study. Setting An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. Participants In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Intervention Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. Measurements We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. Results No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P < .001. Length of acute hospital stay was significantly shorter in patients discharged to home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P < .001]. Conclusion The hospital-at-home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs.
publishDate 2017
dc.date.none.fl_str_mv 2017
2024
2024
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 http://hdl.handle.net/10609/150697
https://doi.org/10.1016/j.jamda.2017.04.006
url http://hdl.handle.net/10609/150697
https://doi.org/10.1016/j.jamda.2017.04.006
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Journal of the American Medical Directors Association, 2017, 18(9)
https://doi.org/10.1016/j.jamda.2017.04.006
dc.rights.none.fl_str_mv © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine
info:eu-repo/semantics/embargoedAccess
rights_invalid_str_mv © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine
eu_rights_str_mv embargoedAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:O2, repositorio institucional de la UOC
instname:Universitat Oberta de Catalunya (UOC)
instname_str Universitat Oberta de Catalunya (UOC)
reponame_str O2, repositorio institucional de la UOC
collection O2, repositorio institucional de la UOC
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