Hospital-Level Care at Home for Acutely Ill Adults

Levine, David M.; Ouchi, Kei; Blanchfield, Bonnie B.; Saenz, Agustina; Burke, Kimberly; Paz, Mary; Diamond, Keren; Pu, Charles T.; Schnipper, Jeffrey L.

doi:10.7326/m19-0600

Cited by 255 publications

(248 citation statements)

References 39 publications

Supporting

Mentioning

211

Contrasting

Unclassified

Order By: Relevance

“…However, in our prior studies using the same EHR with phone calls and a regional health information network to confirm utilization, we found that acute care at an outside system following discharge was exceedingly low. 33 Third, although possibly uncommon, a family could have expressed the desire for discharge to home with an advanced directive specifying home-first palliative care. In this case, the patient would have passed away and been counted as having reached the composite endpoint, though this is the optimal outcome in these cases.…”

Section: Discussionmentioning

confidence: 99%

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

Levine

Lipsitz

et al. 2020

J GEN INTERN MED

Self Cite

View full text Add to dashboard Cite

Background Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable. Objective Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19. Design Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up. Participants All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA. Main Measures Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve. Key Results Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients. Conclusions A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources.

show abstract

Section: Discussionmentioning

confidence: 99%

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

Levine

Lipsitz

et al. 2020

J GEN INTERN MED

Self Cite

View full text Add to dashboard Cite

show abstract

“…This led to some potentially relevant articles being excluded. For instance, two promising RCTs were identified during the literature search and selection process which found that adult HaH patients may around 2.6 times more active than inpatients [43,44], however, these studies were excluded as it was not possible to isolate the results for participants aged over 60 years-only. A further limitation of this review is the high risk of bias present in the studies identified, which may limit the representativeness of the findings.…”

Section: Strengths and Limitations Of This Reviewmentioning

confidence: 99%

A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field

et al. 2020

View full text Add to dashboard Cite

Purpose The purpose of this review was to identify, evaluate and synthesise existing evidence reporting the physical activity levels of acutely ill older patients in a ‘Hospital At Home’ setting and compare this to patients with similar characteristics treated in a traditional hospital inpatient setting. Functional changes and any adverse outcomes due to physical activity (e.g. falls) in both settings where PA was reported or recorded were also evaluated as secondary outcomes. Methods A search strategy was devised for the MEDLINE, CINAHL, AMed, PEDRO, OT Seeker and Cochrane databases. Search results were title, abstract and full-text reviewed by two independent researchers. Data were extracted from included articles using a custom form and assessed for quality and risk of bias using the Appraisal Tool for Cross-Sectional Studies. Results No studies set in the Hospital at Home environments were identified. 16 hospital inpatient studies met the criteria for inclusion. Older patients managed in inpatient settings that would be eligible for Hospital at Home services spent 6.6% of their day active and undertook only 881.8 daily steps. Functional change was reported in four studies with both improvement and decline during admission reported. Conclusion There is a lack of published research on the physical activity levels of acutely-ill older adults in Hospital at Home settings. This review has identified a baseline level of activity for older acutely ill patients that would be suitable for Hospital at Home treatment. This data could be used as a basis of comparison in future hospital at home studies, which should also include functional change outcomes to further explore the relationship between physical inactivity and functional decline.

show abstract

“…Diversos autores han publicado experiencias positivas con respecto a la hospitalización domiciliaria tanto en estudios controlados y no controlados, en los países donde se ha implementado. Demostrando múltiples beneficios, tanto para el centro asistencial en relación a la reducción del costo económico en las estancias hospitalarias (2,7,8) y a la optimización del recurso cama (3) , como también beneficios directos para el paciente, tales como el recibir una atención más humanizada, aumentando su comodidad y bienestar al encontrarse en su propio hogar, mejorando la participación y la responsabilidad del paciente con respecto a su propia salud, haciendo partícipe de este proceso también a la familia, entre otras cosas (1,6,9,10) .…”

Section: Beneficios Y Desventajas De La Hospitalización Domiciliariaunclassified

Kinesiología en las unidades de hospitalización domiciliaria en Chile

Navarro

Figueroa

et al. 2021

Hosp Domic

View full text Add to dashboard Cite

Introducción: La hospitalización domiciliaria nace con el objetivo de ser una alternativa a la hospitalización tradicional, similar en recursos y complejidad. Dentro de las prestaciones que se puede entregar, se encuentra la kinesiología. Sin embargo, no existen información específica sobre el perfil ni el quehacer de estos profesionales en dichas unidades. Por lo que se busca con este trabajo, describir y caracterizar el trabajo de los kinesiólogos/as que se desempeñan en unidades de hospitalización domiciliaria en hospitales públicos de Chile.Materiales y Método: Estudio descriptivo transversal realizado mediante una encuesta a kinesiólogos/as que trabajan en unidades de hospitalización a domicilio en hospitales públicos de Chile. Realizada entre marzo y agosto de 2019. Para el análisis estadístico se utilizó el software Rstudio.Resultados: De 82 hospitales encuestados, 59 cuentan con hospitalización domiciliaria, de estos, 45 cuentan con kinesiología. Dentro de las áreas más desarrolladas en adultos, son la kinesiología respiratoria (95,3%), la kinesiología motora (93,4%), y la neurorrehabilitación (90,1%). En pediatría es la kinesiología respiratoria (28,1%). El 32% de las unidades cuenta con un coordinador/a de profesión kinesiólogo/a.Conclusiones: La kinesiología permite entregar diferentes prestaciones en domicilio tanto a adultos como niños. Sin embargo, esto surge según la necesidad de cada hospital y no está definido a nivel nacional, por lo que se propone avanzar hacia lineamientos que permitan la estandarizar la incorporación de esta profesión a todas las unidades de hospitalización domiciliaria.

show abstract

Hospital-Level Care at Home for Acutely Ill Adults

Cited by 255 publications

References 39 publications

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019

A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field

Kinesiología en las unidades de hospitalización domiciliaria en Chile

Contact Info

Product

Resources

About