Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan.
Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan.
Fam Pract. 2023 Dec 22;40(5-6):662-670. doi: 10.1093/fampra/cmad010.
Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with coronavirus disease (COVID-19). Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organized by a team of local primary care clinics.
We conducted a multicentre retrospective cohort study of the COVID-19 patients who received our HaH care from 1 January to 31 March 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka city were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment.
Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only 1 home visit in addition to online treatment.
The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.
居家医院（HaH）护理已被提议作为新冠肺炎患者住院治疗的替代方案。先前的报告是由医院主导的，涉及在医院分诊的患者。为了减轻医院的负担，我们构建了一种由当地初级保健诊所团队组织的新型 HaH 护理模式。
我们对 2022 年 1 月 1 日至 3 月 31 日期间接受 HaH 护理的新冠肺炎患者进行了一项多中心回顾性队列研究。纳入的患者是由大阪市专门负责管理新冠肺炎患者的卫生中心单独分诊为无需住院治疗的患者。主要结局是接受 HaH 护理以外的医疗护理，定义为初始治疗后 30 天内任何医疗咨询、住院或死亡的复合结局。
在 382 名符合条件的患者中，有 34 名（9%）在初次就诊后立即被分诊住院。在其余 348 名接受随访的患者中，有 37 名（11%）发生了主要结局，而无人死亡。基线时的肥胖、发热和胃肠道症状与需要 HaH 护理以外的医疗护理的风险增加独立相关。进一步有 129 名（37%）患者仅接受在线管理而无需家访，170 名（50%）患者除了在线治疗外仅需要 1 次家访。
由初级保健诊所团队组成的 HaH 护理模式能够在不涉及医院的情况下分诊需要立即住院治疗的新冠肺炎患者，并在家中治疗大多数其余患者。
