Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

Mas, Miquel Àngel; Inzitari, Marco; Sabaté, Sergi; Santaeugènia, Sebastià; Miralles, Ramón

doi:10.1093/ageing/afx099

Cited by 36 publications

(33 citation statements)

References 19 publications

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“…In the UK, this typically involves a consultation with a primary care practitioner in a practice (also known as a surgery, clinic or community health centre) but in an appointment that is usually too time limited to undertake CGA. Established avenues for onward referral include community-based services that perform in-home CGA assessment such as communitybased geriatric services [11], or secondary care services with review by a geriatrician in an outpatient clinic. There currently appears no established method of assessing these patients within the primary care practice itself.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive geriatric assessment in primary care: a systematic review

et al. 2019

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Background Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. Aim To appraise the evidence on CGA implemented within the primary care practice. Methods The review followed PRISMA recommendations. Eligible studies reported CGA on persons aged ≥ 65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed. Results The authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n = 3) or nurse practitioner (n = 1), with varied length and extent of follow-up (12-48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. Discussion The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA.

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Section: Introductionmentioning

confidence: 99%

Comprehensive geriatric assessment in primary care: a systematic review

et al. 2019

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“…These positive findings are consistent with the findings of previous home-based geriatric rehabilitation studies. 6 – 8 , 34 …”

Section: Discussionmentioning

confidence: 99%

“… 2 – 5 A cohort study on orthopedic older patients suggested that home intervention significantly shortened the duration of rehabilitation and enhanced its efficiency ( P <0.01). 6 Two pragmatic randomized controlled trials (RCTs) with similar designs, from the UK (N=250) 7 and Sweden (N=205), 8 suggested that community in-reach rehabilitation and care transition could reduce hospital stay for 2.3 and 6 days, respectively. Effective rehabilitation programs can enhance clients’ physical functioning and mobility through tailored and individualized physical training.…”

Section: Introductionmentioning

confidence: 99%

“…Fourth, networks of the HBRS therapists across hospitals and the community will enable them to act similar to case managers who can refer clients or caregivers to the appropriate health or social resources. Compared with Mas et al, 6 Sahota et al, 7 and Karlsson et al, 8 the current study’s HBRS covers clients who have not been recently hospitalized and includes a larger range of clients who suffer from various health conditions, such as cardiovascular diseases, musculoskeletal problems, neurological problems, respiratory problems, cancers, and falls.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study

Lee

Yau

Yim

et al. 2018

CIA

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IntroductionPrevious studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients.MethodsThis study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated.ResultsThe final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months.ConclusionHBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.

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“…We suggest that optimal care for frailty and system benefits will not be realised until well coordinated health and social care assessment and support can be accessed across care settings and at all times. We consider this can be facilitated by remote monitoring and decision support in the community and by urgent access to intermediate care or transition services such as Hospital at Home [1617]. …”

Section: Cga + Care Transitionsmentioning

confidence: 99%

Integrated Care: A Collaborative ADVANTAGE for Frailty

Hendry¹,

Cariazo²,

Vanhecke³

et al. 2018

International Journal of Integrated Care

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Frailty is increasingly recognised as a public health priority due to the associated demand for acute and longer term health and social care support, and the impact on the lives of individuals, caregivers and families. Integrated care is widely considered to be most effective when applied to an older population, but there is limited data on outcomes and costs from studies of integrated care to prevent and manage frailty. This paper describes work by the ADVANTAGE Joint Action (JA), co-funded by the European Union and 22 Member States, to develop a common European approach to the prevention and management of frailty. The authors reflect on the emerging evidence and experience of implementing integrated care for frailty, and invite readers to participate in ongoing dialogue on this topic through the ADVANTAGE JA website and IFIC Academy activities.

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Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

Abstract: in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.

Cited by 36 publications

References 19 publications

Comprehensive geriatric assessment in primary care: a systematic review

Comprehensive geriatric assessment in primary care: a systematic review

Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study

Integrated Care: A Collaborative ADVANTAGE for Frailty

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