Cost‐Effectiveness of a Barcelona Home Care Program for Individuals with Multimorbidity

Abstract

To improve the efficiency and effectiveness of care and optimize healthcare resources, a home healthcare program was created for individuals with multiple chronic conditions. Demographic and clinical characteristics of the 261 individuals (mean age 84) included in the program from its inception in 2011 through 2013 (mean stay in the program 203±192 days) were prospectively analyzed. The number of hospital admissions, length of stay, and costs for individuals admitted to the program were compared for two time periods: the 6 months before admission to the program and their stay in the program. After admission to the program, the number of hospital admissions and the hospital length of stay per person per month decreased from 0.36±0.21 to 0.19±0.52 (P<.001) and from 3.5 to 1 day (P<.001), respectively. Surveys of randomly selected patients and caregivers showed high satisfaction with the program. Costs per person per day decreased from €54.65 (US$73.12) to €17.91 (US$23.96), a reduction of 67.1%. Fewer admissions and shorter hospital stays enabled the hospital to eliminate one acute bed for every 50 individuals admitted to the program. In conclusion, home care for individuals with chronic illness with multimorbidity reduced the number of hospital admissions and length of stay, resulting in good patient satisfaction and lower costs.

Effectiveness of Intensive Primary Care Interventions: A Systematic Review

“…Of these, we included 11 randomized controlled trials [31][32][33][34][35][36][37][38][39][40][41] and seven observational studies. [42][43][44][45][46][47][48] Tables 2 and 3 summarize the study and intervention characteristics. The majority of the studies involved mostly elderly, Studies that include a follow-up period of more than 30 days Setting:…”

“…Three studies selected patients based on high utilization of inpatient or emergency department services. 39,44,47 The remaining studies selected patients who were at least moderately disabled in activities of daily living 31, 35-38, 48, 57 ; homeless 46 ; aged ≥ 65, 31,33,34,48,58 ≥ 67, 45 ≥ 70, 32,35 or ≥ 75 years 42 ; had income below 200% of the federal poverty level 34,58 ; and/or who met nursing home eligibility criteria. 43 Detailed patient selection criteria are described in Table 2.…”

“…Among the programs, five were home-based primary care replacement models (referred to as home-based care models), where a dedicated interdisciplinary primary care team delivered all needed services in patients' homes. [36][37][38]44 Five were clinic-based primary care replacement models (referred to as clinic-based IPC), where patients transferred care from their regular primary care physicians to dedicated clinics that provided only high-intensity care, 31,32,43,57 and eight used primary care augmentation, where additional highintensity services enhanced ongoing care from their regular primary care physician. 33-35, 39, 42, 58 Because of the clinical heterogeneity in design, patient population, interventions, and outcome assessment methods, we did not pool any data across studies.…”

“…In this review, we identified 18 studies of IPC interventions and categorized them into three major types: home-based 45 Hughes et al, 1990 36 Hughes et al, 2000 37 VA HBPC/HBHC Hospital-based home care (HBHC) to Bheavy care^patients (terminally ill and severely disabled), alternative to nursing home. Management inside and outside of hospital; integrated networks; 24-h contact; salaried physicians who designate a specific percentage of time Melin, 1995 38 In-home hospital care as alternative to in-hospital care prompted by bed availability crisis; patients at risk of long-stay care; rehab on a round-the-clock basis Vila et al, 2015 44 Home health care; continued proactive monitoring for early detection and treatment of disease exacerbation: direct telephone available 12 h a day; rapid (≤ 6 h) mobilization of intensive hospital home care (IV drug therapy, oxygen therapy, comprehensive assessment within 24 h of discharge) Clinic-based Multidisciplinary team (nurse practitioner, physician, social worker, recreational therapist) partnered with patients' medical home, comprehensive patient assessment and tracking, care management of medical and social service needs, frequent contact, and coordination of care with VA and non-VA clinicians programs, clinic-based IPC, and primary care augmentation programs. The programs varied in the way they identified and screened patients for enrollment, though most focused on older adults with functional limitations.…”

“…36,37 Other homebased programs implemented by single centers in Barcelona and Stockholm had mixed findings regarding hospital utilization, but our confidence in these findings is very low due to their serious limitations. 38,44 For example, it is possible that the reduced hospital utilization in Hospital de Barcelona's home care program was exaggerated, because the urban setting characteristic of this home care program is typically associated with higher health care utilization than the rural setting of the control group. 59 Similarly, in Stockholm's in-home hospital care program, the reduction in long-stay hospital utilization at 6 months may have been exaggerated, because participants in the home care group had a higher number of medical diagnoses than the control group (4.5 vs. 3.9; P = 0.003).…”