Home First! Identification of Hospitalized Patients for Home-Based Models of Care

Abstract

Objectives: To determine the proportion of hospitalized inpatients suitable for an acute and subacute home-based inpatient bed substitutive service, to examine the ability of treating teams to identify suitable patients for this service, and to examine potential barriers toward inpatients receiving home-based care. Design: Prospective point prevalence study over 2 days in April 2019; analysis of responses to survey questionnaires regarding the suitability for home-based care among inpatients with multiday admissions to acute and subacute wards in the Royal Melbourne Hospital (RMH), an Australian metropolitan tertiary referral center. Setting and Participants: Ward treating teams, clinicians affiliated with the home-based service called RMH@Home, and inpatients who were subsequently identified as being suitable for home-based care. Measurements: Point prevalence and characteristics of inpatients suitable for a home-based bed substitutive service; identified by either treating teams or RMH@Home clinicians; and barriers to the provision of home-based care among ward inpatients. Results: Survey responses were received for 620 of 635 inpatients [median age 69 years (interquartile range 53e81), 53% male], of which 69 (11.1%) were identified as being suitable for home-based inpatient bed substitution care. Treating team clinicians identified 26 patients, clinicians affiliated with RMH@Home identified a further 43 suitable patients. The most commonly reported barrier (38.1%) toward receiving home-based care was functional disability impeding ability to live at home. Conclusions and Implications: A substantial proportion of hospitalized older patients could use home-based inpatient bed substitutive services. Clinicians experienced in home-based care are more skilled than ward-based clinicians in identifying suitable patients for this care model.

Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings

“…Furthermore, this study is limited by the small sample size of patients included in the home-based group, as data collection was stopped early due to the COVID-19 pandemic and the home-based service only operated with 15 beds at the time of accelerometry data collection, which has since been expanded because of successful implementation and increasing demand. 18 However, we confirmed that sample sizes were large enough to perform the analyses presented. 50…”

“…Patients, who would have otherwise received hospital-based care, are deemed suitable for home-based care by physicians to ensure medical stability, ability to independently transfer and use the toilet safely, and adequate cognitive capacity. 18 Patients in both settings were assessed by a Comprehensive Geriatric Assessment 19 by physicians, nurses, occupational therapists and physiotherapists within 48 hours of admission and discharge and followed up at 3 months via phone interviews. This study was approved by XXXX Q 5…”

Características clínicas y epidemiológicas de los pacientes ingresados en la Unidad de Hospitalización Domiciliaria del Hospital Regional de Talca durante el año 2019

“…Conocer la patología del paciente es primordial para abordar al mismo de forma eficiente, expedita e integral, por eso fue muy importante determinar cuáles fueron las patologías que más se derivaron a la unidad de hospitalización domiciliaria, en total hubo una cantidad de 62 diferentes diagnósticos de todas las áreas de la medicina pero solo se estratifican las que tuvieron mayor incidencia, siendo la que más ingresos tuvo fue las ITU con 156 diagnósticos lo que representa un 32,2% del total de los ingresos, luego le sigue la Neumonía con 45 pacientes diagnosticados lo que representa el 9,3% del total, lo cual tiene correlación con los ingresos realizados en un estudio australiano de derivaciones a su unidad de hospitalización domiciliaria (3) , continuamos con la Trombosis venosa profunda con 38 pacientes que representa el 7,9%, el siguiente diagnóstico es el trastorno del ritmo cardiaco (FA) con 30 pacientes con esta indicación que representa el 6,2% del total, luego tenemos la siguiente indicación que tuvo 25 diagnósticos que fue la ECV y que representa el 5,2%, continuamos con la Exéresis de ortejos del pie diabético que tuvo 20 diagnósticos y representa el 4,1% del total, luego tenemos tres diagnóstico, UPP, infección de herida operada, dehiscencia o evisceración y úlcera que tuvieron 18 indicación cada uno que representan el 3,7% respectivamente, también tenemos la Celulitis que se diagnosticó 15 veces y representa el 3,1% del total, y por último tenemos dos la EPOC exacerbado que tuvieron 13 indicaciones que representa el 2,7%.…”

“…El advenimiento de las tecnologías de telemedicina con la capacidad de monitorear de forma remota el estado clínico de los pacientes y realizar consultas de telesalud puede ayudar a abordar las barreras geográficas, reduciendo así la incertidumbre clínica y permitiendo una detección más temprana del deterioro mientras los pacientes están en casa (3) .…”

“…La hospitalización domiciliaria surgió como un método alternativo para brindar tratamientos médicos agudos, subagudos y un postquirúrgico rentables y programas de rehabilitación a los pacientes en sus propios hogares. Se asocia con tasas más bajas de mortalidad y reingreso de pacientes hospitalizados, y una mayor satisfacción de pacientes y cuidadores (3) .…”