Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment
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- dc.contributor.author Hernández, Carme
- dc.contributor.author Aibar, Jesus
- dc.contributor.author Seijas, Nuria
- dc.contributor.author Puig, Imma
- dc.contributor.author Alonso, Albert
- dc.contributor.author García Aymerich, Judith
- dc.contributor.author Roca, Josep
- dc.date.accessioned 2020-02-10T08:23:15Z
- dc.date.available 2020-02-10T08:23:15Z
- dc.date.issued 2018
- dc.description.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.
- dc.description.sponsorship The publication of the current work has been fully supported by CONNECARE (UE Grant n° 689802).
- dc.format.mimetype application/pdf
- dc.identifier.citation Hernández C, Aibar J, Seijas N, Puig I, Alonso A, Garcia-Aymerich J et al. Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment. Int J Integr Care. 2018;18(2):12. DOI: 10.5334/ijic.3431
- dc.identifier.doi http://dx.doi.org/10.5334/ijic.3431
- dc.identifier.issn 1568-4156
- dc.identifier.uri http://hdl.handle.net/10230/43534
- dc.language.iso eng
- dc.publisher Ubiquity Press
- dc.relation.ispartof International Journal of Integrated Care. 2018;18(2):12
- dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/689802
- dc.rights © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Home hospitalization
- dc.subject.keyword Chronic patients
- dc.subject.keyword Integrated care
- dc.subject.keyword Telemedicine
- dc.subject.keyword Transitional care
- dc.title Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion