Western Health and Social Care Trust, Londonderry, UK.
School of Nursing and Institute of Nursing and Health Research, Ulster University, Derry, UK.
J Clin Nurs. 2021 Oct;30(19-20):2978-2989. doi: 10.1111/jocn.15805. Epub 2021 Jul 3.
This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward.
Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness.
Quantitative design, using service evaluation methodology.
A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018-March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30-day, 3- and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study.
Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Fewer patients die while under Acute Care at Home care. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts.
The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. It is likely that the Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults.
Acute Care at Home services continue to evolve worldwide. This service evaluation has confirmed that Acute Care at Home services are safe and cost-effective alternatives to traditional older people hospital services. Such services offer patient choice, reduce length of stay and costs and prevent functional decline of older adults. This study accentuates the need to expand Acute Care at Home provision and capacity throughout Northern Ireland.
本研究评估了顾问主导的急性护理居家服务与传统住院到老年病房的比较影响。
全球范围内，由于人口增长、慢性病增加和人口老龄化，对医疗保健服务的需求不断增加。急性护理居家服务在患者自己的家中提供急性、医院水平的护理。自 2014 年以来，北爱尔兰已经开设了五个此类服务，但是对其可行性和有效性的研究有限。
使用服务评估方法的定量设计。
对 2018 年 4 月至 2019 年 3 月期间入住北爱尔兰老年病房（n=191）和顾问主导的急性护理居家服务（n=314）的患者的入院人口统计学数据和出院后临床结果进行了为期 1 年的回顾性图表审查。使用描述性和推断性数据分析方法（包括频率、独立 t 检验和卡方分析）分析数据。测量的结果包括住院时间、30 天、3 个月和 6 个月的再入院率和死亡率、功能能力和出院时的居住地。本研究采用 STROBE 清单进行报告。
急性护理居家服务与 30 天、3 个月和 6 个月的再入院率和死亡率较高相关。在急性护理居家服务下，患者死亡人数较少。接受急性护理居家服务的患者住院时间缩短，家庭护理包的升级减少，出院后不太可能需要亚急性康复。两组患者的性别、年龄和早期预警评分无差异。
急性护理居家服务是老年患者住院的可行替代方案。它可以防止功能下降以及对家庭护理或疗养院的需求。急性护理居家服务的死亡率和再入院率较高，可能是因为它治疗的依赖型、虚弱的老年患者比例较高。
急性护理居家服务在全球范围内继续发展。本服务评估证实，急性护理居家服务是传统老年人医院服务的安全且具有成本效益的替代方案。此类服务提供了患者选择，缩短了住院时间和成本，并防止了老年人的功能下降。本研究强调了在整个北爱尔兰扩大急性护理居家服务的提供和能力的必要性。
