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

Closa, Conxita; Mas, Miquel Àngel; Santaeugènia, Sebastià; Inzitari, Marco; Ribera, Aída; Gallofré, Miquel

doi:10.1016/j.jamda.2017.04.006

Cited by 33 publications

(33 citation statements)

References 20 publications

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“…Two systematic reviews were published recently ( 8 , 9 ) that evaluated the effectiveness of HBR for patients with fractures of the femoral neck, but most studies included in the review related to ongoing rehabilitation processes and not intensive rehabilitation immediately after surgery. Table 1 shows a summary of the main findings of six studies ( 10 – 15 ) that compared the effectiveness of HBR with that of standard inpatient rehabilitation (IR). In some of the studies, HBR was more effective than IR.…”

Section: Introductionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks. Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R). Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group. Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.

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Section: Introductionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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“…Previous studies comparing HaH and CH [5,13,[20][21][22] have reported that home care can have similar results to CH and would save both human and economic resources [23][24][25][26]. In this sense, both the results obtained and the available evidence suggest that, provided the patient's indication permit it and new causal research confirm them, HaH treatment could be a suitable, effective, and perhaps efficient alternative to CH [10,19,24,27].…”

Section: Discussionmentioning

confidence: 80%

Differences in results and related factors between Hospital-at-Home modalities in Catalonia: a cross sectional study

Torre

Zioga

Macorigh

et al. 2020

Preprint

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Background 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. Previous studies have described two basic types of HaH: hospital admission avoidance and early discharge The aims of this study were: To describe the characteristics of different types of hospital-at-home (HaH) contacts; to assess readmission, mortality, and mean length of stay for each HaH modality; and to examine which factors could be related to these results. Methods 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=7,214; 75.1%) and early discharge (n=2,387; 24.9%). The main outcome indicators were readmission, mortality, and mean length of stay (days). Contact characteristics were compared at bivariable level and indicators were calculated for each HaH modality. Multivariable General linear models were fitted to assess the association between explanatory factors and outcomes. Results Differences in contact characteristics between HaH modalities were observed at bivariable level. 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 discharge one, 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. Conclusions The results show that the HaH results in Catalonia are acceptable and similar to those observed in other contexts. The factors related to these results could help improve the effectiveness and efficiency of the different HaH modalities.

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“…We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit. It would be interesting to test in France the implementation of modern and individual programs of rehabilitation outside the hospital, such as those from Norway,Suede and Spain (49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

Laurent

Oubaya

Poitrine

et al. 2020

Preprint

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Background: Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods: We used a prospective cohort of consecutive patients aged ≥ 75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results : Among the 252 eligible patients, 165 (median age 85 years [interquartile range (IQR) 81-90] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [9-13], 24 (14.5%) had a pulmonary HAI; 30 (18.2%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P=0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P=0.03, or psychiatric disease, P=0.02) and albumin level < 35 g/l (p=0.02). Significant association were found between functional decline and CIRS-G for respiratory diseases (CIRS-G-R) (OR 2.82 [95% CI 1.18-6.71], p=0.016), between functional decline and pulmonary HAI (OR 4.09 [1.48-11.34],p=4.09), and between CIRS-G-R and pulmonary HAI (OR 10.9 [5.26-22.5],p=0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 1.91 [0.71-5.16], p=0.20) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion : Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

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

Cited by 33 publications

References 20 publications

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

Differences in results and related factors between Hospital-at-Home modalities in Catalonia: a cross sectional study

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

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