Differences in Results and Related Factors between Hospital-At-Home Modalities in Catalonia: A Cross-Sectional Study

Abstract

Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.

Outpatient parenteral antimicrobial therapy with continuous infusion of meropenem: A retrospective analysis of three years of clinical experience

“…different than hospitalization wards) in the last years, in an attempt of enhance an admission avoidance HaH modality. 24 The complexity of our patients and of their infections justifies a relative long length of stay.…”

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service

“…The service provides acute, home-based, short-term care aiming at either entirely replacing conventional hospitalization (hospital avoidance) or accelerating discharge (early discharge). This model was progressively implemented across the entire healthcare system in our region between 2011 and 2015, with preliminary positive results [ 23 – 25 ]. These positive results prompted the Catalan Health Service, the only public health payer providing universal healthcare to the 7.7 million population, to scale up the HaH service across the region and set a specific reimbursement model between 2016 and 2020 [ 26 ].…”

The Value of Admission Avoidance: Cost-Consequence Analysis of One-Year Activity in a Consolidated Service

“…The service provides acute, home-based, short-term care aiming at either entirely replacing conventional hospitalization (hospital avoidance) or accelerating discharge (early discharge). This model was progressively implemented across the entire healthcare system in our region between 2011 and 2015, with preliminary positive results [7,17,18]. These positive results prompted the Catalan Health Service, the only public health payer providing universal healthcare to the 7.7 million population, to scale up the HaH service across the region and set a specific reimbursement model between 2016 and 2020 [19].…”