Vilà Anna, Villegas Eulàlia, Cruanyes Jordi, Delgado Rosa, Sabaté Rosa-Ana, Ortega Josep, Araguás Cristina, Humet Carlos
Program for the Care of Patients with Multimorbidity, Hospital de Barcelona SCIAS, Grup Assistència, Barcelona, Spain.
J Am Geriatr Soc. 2015 May;63(5):1017-24. doi: 10.1111/jgs.13396. Epub 2015 May 4.
To improve the efficiency and effectiveness of care and optimize healthcare resources, a home healthcare program was created for individuals with multiple chronic conditions. Demographic and clinical characteristics of the 261 individuals (mean age 84) included in the program from its inception in 2011 through 2013 (mean stay in the program 203±192 days) were prospectively analyzed. The number of hospital admissions, length of stay, and costs for individuals admitted to the program were compared for two time periods: the 6 months before admission to the program and their stay in the program. After admission to the program, the number of hospital admissions and the hospital length of stay per person per month decreased from 0.36±0.21 to 0.19±0.52 (P<.001) and from 3.5 to 1 day (P<.001), respectively. Surveys of randomly selected patients and caregivers showed high satisfaction with the program. Costs per person per day decreased from €54.65 (US$73.12) to €17.91 (US$23.96), a reduction of 67.1%. Fewer admissions and shorter hospital stays enabled the hospital to eliminate one acute bed for every 50 individuals admitted to the program. In conclusion, home care for individuals with chronic illness with multimorbidity reduced the number of hospital admissions and length of stay, resulting in good patient satisfaction and lower costs.
为提高护理效率和效果并优化医疗资源，为患有多种慢性病的个体创建了一项家庭医疗保健计划。对2011年至2013年该计划启动以来纳入的261名个体（平均年龄84岁）的人口统计学和临床特征进行了前瞻性分析（在该计划中的平均停留时间为203±192天）。比较了两个时间段内纳入该计划的个体的住院次数、住院时间和费用：纳入该计划前的6个月以及他们在该计划中的停留时间。纳入该计划后，每人每月的住院次数和住院时间分别从0.36±0.21降至0.19±0.52（P<0.001），从3.5天降至1天（P<0.001）。对随机选择的患者和护理人员的调查显示对该计划高度满意。每人每天的费用从54.65欧元（73.12美元）降至17.91欧元（23.96美元），降低了67.1%。住院次数减少和住院时间缩短使医院能够为每50名纳入该计划的个体腾出一张急性病床。总之，对患有多种慢性病的个体进行家庭护理减少了住院次数和住院时间，带来了良好的患者满意度并降低了成本。
