Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
Age Ageing. 2017 Nov 1;46(6):925-931. doi: 10.1093/ageing/afx099.
to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care.
quasi-experimental longitudinal study.
hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain.
we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation.
a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models.
clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days.
in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.
分析西班牙加泰罗尼亚卫生系统中基于家庭的中级护理模式的临床影响，将其与常规卧床护理进行比较。
准实验性纵向研究。
西班牙巴达洛纳市立医院和 El Carme 中级护理医院。
我们纳入了患有需要全面老年评估（CGA）和康复的医学和骨科致残性健康危机的老年患者。
基于 CGA 的医院家庭综合护理计划（急性护理和康复）与接受常规住院医院护理（急性护理加中级护理医院住院治疗）的当代患者进行了倾向评分匹配队列比较，以管理医学和骨科流程。主要结局指标是：（a）健康危机解决（干预结束时转介至初级保健）；（b）功能解决：相对功能增益（功能增益/功能损失）≥0.35；（c）有利的危机解决（健康+功能）=a+b。我们使用单变量/多变量逻辑回归模型比较组间结局。
家庭组和床位组的临床特征相似。家庭组的急性住院时间更短：6.1（5.3-6.9）天与 11.2（10.5-11.9）天，P<0.001。家庭方案在功能解决方面的结果更好：79.1%（75.2%），OR1.62（1.09-2.41）和有利的危机解决 73.8%（69.6%），OR1.54（1.06-2.22），干预时间更短，减少了-5.72（-9.75 和-1.69）天。
在我们的研究中，扩展的基于 CGA 的医院家庭计划与较短的住院时间和有利的临床结果相关。未来的研究可能会将这种干预措施应用于整个加泰罗尼亚综合护理系统。
