Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment

Abstract

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored.Objective:To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona.Methods:Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients’ and professionals’ perspectives, technologies and costs were evaluated.Results:4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0–3) days and the length of home-based stay was 6 (5–7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services.Conclusions:The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

“…Those were mostly from the USA ( n = 5) and Singapore ( n = 3), followed by a few European countries. For example, Hernández et al [ 70 ] reported reduced in-hospital days following a hospital outreach telemedicine monitoring service for a large group of patients with chronic illnesses ( n = 4165). Furthermore, all patients, carers and health professionals involved in the programme expressed high levels of satisfaction (98%) with the service.…”

Hospital at home for the management of COVID-19: preliminary experience with 63 patients

“…Hospital Clinic is a 750-bed public, tertiary teaching hospital which serves 560,000 people in the metropolitan area of Barcelona. The Hospital Clinic's HaH Unit started providing hospital-level, specialized, health care at patients' homes in 1996 [7]. The HaH Unit has a maximum capacity of 48 patients, with approximately 1200 patients treated each year and a mean length of stay of 7 days (standard deviation 3 days) [8].…”

Class Imbalance Impact on the Prediction of Complications during Home Hospitalization: A Comparative Study

“…After a first exploratory analysis, some variables, such as hemoglobin concentration, lymphocytes and creatinine, were found to unmask statistically significant differences between patients undergoing successful and unsuccessful HH stays. According to the results, blood test data is presented as a potential complementary instrument to health conditions, risk factors and socio-demographic information [18], in order to identify those patients that, if proposed for HH, should be given special attention to avoid eventual regular hospital admissions. However, class imbalance complicates the use of these data for the identification of unsuccessful cases.…”