Mira José Joaquín, García-Torres Daniel, Bonell-Guerrero María Del Mar, Cáceres-Sevilla Ana Isabel, Ramirez-Sanz Martina, Martínez-Lleo Rosa, Carratalá Concepción
Health Psychology Department, Universidad Miguel Hernández, Elche, Spain.
Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO), Alicante, Spain.
Interact J Med Res. 2024 Nov 19;13:e64248. doi: 10.2196/64248.
Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases.
This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers.
A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Consellería Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed.
Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61%). The mortality rate (odds ratio [OR] 61.8, 95% CI 53.2-70.5) was similar between men and women (OR 54.1, 95% CI 47.8-71.5 vs OR 59.7, 95% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US $42,614,846 per 1000 admissions.
Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system.
长期护理医院被认为是应对人口老龄化日益增长的医疗保健需求的有效举措。这些中心有望有助于更好地管理医院床位，并为需要持续护理的患者提供更个性化的护理。在足够长的时间后评估其结果对于评估其影响是必要的。急性和慢性长期延长住院医院（HACLES）于20世纪末在西班牙出现，以应对人口老龄化和慢性病增加的问题。
本研究旨在分析在HACLES接受治疗的患者的特征，特别是分析性别差异，并评估使用这些中心相关的成本节约情况。
基于2022年至2023年期间入住HACLES的65岁及以上患者的数据进行了一项回顾性研究。获取了性别、年龄、家庭同居数据、诊断和合并症、每日药物摄入量以及依赖程度，以描述在HACLES就诊的患者特征。对编码在SIA - Abucasis（版本37.00.03；巴伦西亚自治区卫生厅；巴伦西亚地区使用的数字医疗记录系统）中的数据进行了审查，并使用了描述性统计和比较测试。通过比较综合医院病床的每日成本与HACLES病床的每日成本，计算了HACLES入院的直接成本节约情况。
分析了123名平均年龄为77岁的患者的数据。大多数（n = 81，65.9%）有同居家庭成员作为主要照顾者。姑息治疗是最常见的入院原因（n = 75，61%）。男性和女性的死亡率（优势比[OR] 61.8，95%置信区间53.2 - 70.5）相似（OR 54.1，95%置信区间47.8 - 71.5与OR 59.7，95%置信区间42.2 - 66.0；P = 0.23）。使用 Pfeiffer 量表进行的认知评估在出院时有所改善（平均值3.2，标准差3.2与平均值2.5，标准差3.1；P = 0.003）。与出院到其他机构的患者相比，回家的患者住院时间明显更长（平均值89.8，标准差58.2天与平均值33.1，标准差43.1天；P < 0.001）。估计每1000例入院的直接成本节约为42,614,846美元。
通常在HACLES接受治疗的患者年龄较大，认知障碍和身体依赖程度较高，且很大一部分处于姑息治疗中，这凸显了根据入院患者的个体需求调整护理的重要性。HACLES模式有助于公共卫生系统的可持续性。
