Should alternatives to conventional hospitalisation be promoted in an era of financial constraint?

Pericàs, Juan M.; Aibar, Jesús; Soler, Néstor; López‐Soto, Alfonso; Sanclemente-Ansó, Carmen; Bosch, Xavier

doi:10.1111/eci.12087

Cited by 43 publications

(56 citation statements)

References 98 publications

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“…Among cost analysis techniques, “cost minimisation” means choosing the intervention which, with an equal effect, has a lower cost [6]. Therefore, the use of alternative care models to traditional hospitalisation, that reduce hospital admission without detriment to a health benefit, significantly increases efficiency during the processing of many hospital-level procedures [7]. …”

Section: Introductionmentioning

confidence: 99%

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

et al. 2017

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Background: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. Methods: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. Results: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. Conclusions: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

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Section: Introductionmentioning

confidence: 99%

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

et al. 2017

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“…Por lo tanto, el objetivo adecuado son los resultados de salud del paciente en relación con el coste total. En resumen, el valor en la atención sanitaria se define como los resultados en relación con los costes: la eficiencia (15)(16)(17).…”

Section: Análisis De Costes En Hospitalización a Domiciliounclassified

“…En los últimos años se han sucedido las publicaciones de costes en HAD y en la actualidad disponemos de un cuerpo de evidencia suficiente para poder afirmar que se trata de un modelo asistencial coste-efectivo, aunque no todos los estudios han resultado concluyentes en este sentido (16,(23)(24)(25)(26)(27).…”

Section: Análisis De Costes En Hospitalización a Domiciliounclassified

Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio en España

et al. 2017

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La Hospitalización a Domicilio (HAD) apareció en España hace 36 años con la apertura de diversas unidades. El empuje inicial fue truncado por la falta de liderazgo político y en ocasiones también clínico. La realidad actual ofrece una implantación irregular con disparidad de modelos asistenciales y de recursos. La Sociedad Española de Hospitalización a Domicilio (SEHAD) no ha jugado el papel de liderazgo científico y profesional esperado. Se diseñó el «Plan HAD2020: clave de futuro» como revulsivo. Se trata de un ambicioso proyecto a 4 años para consolidar la HAD como modalidad asistencial. Su despliegue consta de cinco fases. Preparación: se establecieron las bases del plan estratégico (PE). Análisis de situación: se realizó una encuesta nacional a las 106 unidades operativas (datos 2014). Validación del PE: aportaciones y propuestas de actuación de los miembros de SEHAD. Congreso Nacional 2016: presentación y aprobación de conclusiones y propuestas del PE. Fase de despliegue PE: se extenderá hasta el año 2020 y la ejecutarán diversos equipos referentes, repartidos en cinco líneas de trabajo.El objetivo final fijado para el año 2020 consiste en: consensuar un modelo asistencial más homogéneo; promover la formación y reconocimiento profesional de quienes trabajan en la HAD; que cada hospital de España tenga una unidad de HAD; reconocimiento y potenciación por el sistema de salud nacional.HAD2020 ha marcado un punto de inflexión en la SEHAD. El camino trazado y el esfuerzo de todos los profesionales HAD permitirán alcanzar aquella visión que persiguieron los pioneros de la HAD en España.

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“…The problems in the quality and management of medical services challenging health care systems worldwide depend on the pandemic scenario in the progression of common chronic diseases, delayed interventional approaches of reactive medicine, poor economy of health care systems, lack of specialized educational programs, problematic ethical aspects of treatments as well as inadequate communication among professional groups and policymakers [5]. Sustainable answers are many, among which is the ‘quick diagnosis units’ [6], which are often reported with a limited clinical description [7]. Also, relationships with non-profit organizations and with patients' associations, namely Cancer Survivors Network, are increasing their articulation with in- and outpatients' care facilities, providing peer support which get benefits and endorsement by the qualified reference institutions.…”

Section: Overviewmentioning

confidence: 99%

Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine

Trovato

2014

EPMA Journal

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BackgroundClinical research and practice require affordable objectives, sustainable tools, rewarding training strategies and meaningful collaboration.MethodOur unit delivers courses on project design and management promoting ideas, useful skills, teaching and exploring implementation of networks and existing collaborations. We investigated the effectiveness of a sustainable approach of comprehensive diagnosis and care and its usefulness within concrete models of research project teaching methodology.ResultsThe model of predictive, preventive and personalized medicine (PPPM) of adolescent hypertension, developed since 1976 and still active, was displayed. This is a paradigm of comprehensive PPPM aimed at the management of a recognized, but actually neglected, societal and clinical problem. The second model was addressed to the analysis of performance of an outpatient diagnostic and therapy unit and its relationship with the emergency department. Part of the patients, 4,057 cancer patients presenting at the emergency care, were addressed to the outpatient diagnostic and therapy unit for further assessment, treatment and follow-up. The stay in DH was 6.3 ± 2.1 non-consecutive days, with shortage of costs, vs. in-hospital stays. Research planning courses, based on these models, ensued in an increase of competitive project submission and successful funding.DiscussionActive promotion of interdisciplinary knowledge and skills is warranted. Misleading messages and information are detrimental not only to healthy and sick people but, equally, to all health professionals: efforts for basing on evidence by research any statement are needed. The actual pre-requisite of personalized medicine is the coherent and articulated promotion of the professional quality of staff. Health professionals should and can be skilled in sustainable non-invasive diagnostic procedures, in non-pharmacological intervention, in translational research (from epidemiology to personalized therapy) and in timely dissemination of the information.ConclusionRecommendations are provided according to PPPM: proposed models are based on financial sustainability and patient's satisfaction criteria and are addressed to research projects and dissemination also by e-learning. The guidelines of the EU calls in personalized medicine are able to provide a critical added value by accurate planning, transparency of assessment and unbiased reports, dissemination and exploitation.

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Should alternatives to conventional hospitalisation be promoted in an era of financial constraint?

Cited by 43 publications

References 98 publications

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio en España

Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine

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