Evaluation of a Home Hospitalization Program in Patients With Exacerbations of Chronic Obstructive Pulmonary Disease

Lobato, Salvador Díaz; Lorenzo, F. González; Mendieta, M.A. Gómez; Alises, Sagrario Mayoralas; Arechabala, I. Martín; Fernández-Montes, C. Villasante

doi:10.1016/s1579-2129(06)60387-x

Cited by 16 publications

(13 citation statements)

References 28 publications

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“…We included studies from the community, 21 ‐ 24 emergency departments (EDs), 28 ‐ 33 , 36 ‐ 42 , 44 ‐ 48 , 55 , 59 , 70 hospitalisations in departments other than EDs, 11 ‐ 20 , 25 ‐ 27 , 34 , 35 , 43 , 48 ‐ 54 , 56 ‐ 58 , 60 ‐ 69 , 71 and hospital‐based outreach teams and community‐based teams 11 , 13 . ‐ 15 , 21 , 44 , 48 , 69 We excluded long‐term care, outpatient care without any care provided at home, elaborate home care services in which patients in the control group were also at home, paediatric care and obstetric care.…”

Section: Methodsmentioning

confidence: 99%

“…7,8 Most HITH services are nurse based, but they may include doctors and allied health professionals. 9,10 Some focus on specialties (eg, surgical specialties, [11][12][13][14][15][16][17][18][19][20] medical specialties, [21][22][23][24][25][26][27][28][29][30][31][32][33] rehabilitation medicine, 34,35 geriatrics, 36,37 psychiatry, [38][39][40][41][42] infectious diseases, 43,44 respiratory diseases [45][46][47][48][49][50][51][52][53][54][55] or orthopaedics 56 ), diagnostic groups (eg, h...…”

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confidence: 99%

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A meta‐analysis of “hospital in the home”

Caplan

Sulaiman

Mangin

et al. 2012

Medical Journal of Australia

316

217

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Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs. Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012. Study selection: Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years. Data extraction: Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist. Data synthesis: 61 RCTs met the inclusion criteria. HITH care led to reduced mortality (odds ratio [OR], 0.81; 95% CI, 0.69 to 0.95; P = 0.008; 42 RCTs with 6992 patients), readmission rates (OR, 0.75; 95% CI, 0.59 to 0.95; P = 0.02; 41 RCTs with 5372 patients) and cost (mean difference, − 1567.11; 95% CI, − 2069.53 to − 1064.69; P < 0.001; 11 RCTs with 1215 patients). The number needed to treat at home to prevent one death was 50. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies; carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00; 95% CI, − 0.19 to 0.19). Conclusion: HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

A meta‐analysis of “hospital in the home”

Caplan

Sulaiman

Mangin

et al. 2012

Medical Journal of Australia

316

217

View full text Add to dashboard Cite

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“…En este apartado se incluyeron cuatro artículos con 455 pacientes [29][30][31][32] . En pacientes con EPOC con agudización que acudían a urgencias o eran ingresados, distintas intervenciones a domicilio han conseguido reducir los días de estancia 29,30,32 , las nuevas consultas a urgencias 30,32 , o el número de ingresos 29,30 .…”

Section: Hospitalización En El Domicilio/ Tratamiento De Pacientes Counclassified

“…En pacientes con EPOC con agudización que acudían a urgencias o eran ingresados, distintas intervenciones a domicilio han conseguido reducir los días de estancia 29,30,32 , las nuevas consultas a urgencias 30,32 , o el número de ingresos 29,30 . La hospitalización en el domicilio de los pacientes con IC consiguió los mismos resultados en términos de mortalidad o reingreso que la hospitalización convencional 31 .…”

Section: Hospitalización En El Domicilio/ Tratamiento De Pacientes Counclassified

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

Corral‐Gudino

Cengotita-Bengoa

Sánchez

et al. 2017

An Sist Sanit Navar

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revisiones0el paciente y su travesía entre la atención primaria y la hospitalaria. revisión sistemática de ensayos clínicos para la implementación de herramientas para la integración en españa Fundamento. Los servicios de salud evolucionan hacia la integración, con el fin de reducir la fragmentación de la atención, mejorando la eficiencia y los resultados en salud. Este trabajo valora la efectividad de distintas herramientas para la integración en España. Método. Revisión en MEDLINE (última búsqueda: 31 de julio de 2017) de ensayos clínicos realizados en España. El riesgo de sesgo se valoró utilizando la propuesta de la colaboración Cochrane. resultados. Se incluyeron veintiún estudios: hospitalización a domicilio (cuatro estudios, 455 pacientes), consultas externas mediante videoconferencia (tres, 2438), enfermeras de enlace (cuatro, 1051), mejora del autocuidado (cuatro, 1219), monitorización de parámetros biomédicos en domicilio (tres, 162), uso de aplicaciones informáticas (dos, 225) y conciliación de la medicación (uno, 172). La hospitalización a domicilio, las enfermeras de enlace y la mejora del autocuidado redujeron los reingresos en pacientes ancianos, con insuficiencia cardiaca (IC) o enfermedad pulmonar obstructiva crónica (EPOC). La mejora del autocuidado y las enfermeras de enlace disminuyeron la mortalidad en IC. La hospitalización a domicilio disminuyó los días de hospitalización en EPOC. La mejora del autocuidado redujo el número de visitas a consulta en asma. La consulta externa mediante videoconferencia disminuyó el tiempo hasta el diagnóstico y el tratamiento en áreas rurales. La calidad de la evidencia fue baja o muy baja ya que los estudios tenían dos o más riesgos de sesgo. Conclusiones. La aplicación de herramientas para la integración mejoró algunos resultados en salud en pacientes con enfermedades crónicas, aunque la evidencia es escasa. De todas las herramientas cabe destacar la mejoría en los resultados conseguida con el autocuidado. Palabras clave. Continuidad del cuidado. Cuidado en atención primaria. Hospital a domicilio. Auto-cuidado. Pacientes no ingresados. ABsTrACTBackground. Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. This study estimates the effectiveness in of different tools for integrated care in Spain. Methods. We performed a systematic review of articles using MEDLINE (last search July31 st , 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment.

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“…Díaz Lobato 133 Man 148 Martin 134 McGeoch 135 Rea 117 Rice 137 Ries 138 Seymour 139 Smith 140 Soler 143 Sridhar 142 Tougaard 143 Trappenburg 144 Wakabayashi 145 Wong 146 Wood- Baker 147 Overall (I 2 = 37.4%, p = 0.017) The details of the characteristics of each included study are summarised in Table 8 and further details are available in Blakemore et al 112 Table 9 shows the characteristics of the different interventions employed in each study in the review. Figure 14 shows the combined effect across the 39 independent studies.…”

Section: -181mentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Evaluation of a Home Hospitalization Program in Patients With Exacerbations of Chronic Obstructive Pulmonary Disease

Cited by 16 publications

References 28 publications

A meta‐analysis of “hospital in the home”

A meta‐analysis of “hospital in the home”

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

CHOICE: Choosing Health Options In Chronic Care Emergencies

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