Mazzarone Tessa, Pérez Laura M, Villa Lorena, Planesas-Pérez Oriol, Verri Filippo M, de Andrés Ana, Luna Ana Gonzalez-de, Velarde Maria F, Martí-Tarradell Roger, Inzitari Marco, Ribera Aida
Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy.
Research on Aging, Frailty and Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), C/ Esteve Terradas 30, Barcelona 08023, Catalunya, Spain.
Age Ageing. 2025 May 31;54(6). doi: 10.1093/ageing/afaf162.
To compare the effectiveness and safety of Hospital-at-Home based on Comprehensive Geriatric Assessment (CGA-HaH) for older adults with bed-based Intermediate Care Unit (BBU).
Cohort study comparing all consecutive CGA-HaH cases managed between January 2018 and December 2023 with contemporary BBU-matched controls at the largest geriatric care provider in Barcelona.
We linked all intermediate care admissions at Parc Sanitari Pere Virgili to the Catalan health information system data to track patients' trajectories from 6 months before the index episode to June 2024. Patients admitted to CGA-HaH were matched to BBU controls using propensity score matching (PSM) based on their baseline characteristics. We used multivariable linear regression to assess the association of CGA-HaH with the percentage of days spent at home (%DSH) and Cox regression to assess the risk of death and first re-hospitalisation.
We included 1180 consecutive CGA-HaH and 10,528 BBU episodes. CGA-HaH patients were significantly older and more functionally impaired and had better socioeconomic status. After PSM, we compared 961 CGA-HaH and 961 BBU patients, with a mean follow-up of 705 days (SD 593). CGA-HaH patients had a 7.4 higher %DSH (95% CI: 4.5-10.2, P < 0.001) with similar first re-hospitalisation [HR 1.02 (95% CI: 0.91-1.1)] and mortality risk [HR: 0.93 (95% CI: 0.81-1.06)].
Our results suggest that CGA-Hospital-at-Home is a viable alternative to traditional inpatient intermediate care for older adults, offering relevant advantages such as increased time spent at home without a rise in mortality.
比较基于综合老年评估的居家医院模式（CGA-HaH）对入住床位式中级护理单元（BBU）的老年人的有效性和安全性。
队列研究，比较2018年1月至2023年12月期间所有连续接受CGA-HaH治疗的病例与巴塞罗那最大的老年护理机构中同时期匹配的BBU对照病例。
我们将圣佩雷·维吉尔疗养院所有中级护理入院病例与加泰罗尼亚健康信息系统数据相链接，以追踪患者从索引事件前6个月到2024年6月的病程轨迹。采用倾向得分匹配（PSM）方法，根据基线特征将接受CGA-HaH治疗的患者与BBU对照进行匹配。我们使用多变量线性回归评估CGA-HaH与在家度过的天数百分比（%DSH）之间的关联，并使用Cox回归评估死亡风险和首次再住院风险。
我们纳入了1180例连续的CGA-HaH病例和10528例BBU病例。CGA-HaH患者年龄显著更大，功能障碍更严重，社会经济地位更好。PSM后，我们比较了961例CGA-HaH患者和961例BBU患者，平均随访705天（标准差593）。CGA-HaH患者的%DSH高7.4（95%置信区间：4.5-10.2，P<0.001），首次再住院情况相似[风险比1.02（95%置信区间：0.91-1.1）]，死亡风险也相似[风险比：0.93（95%置信区间：0.81-1.06）]。
我们的结果表明，居家医院模式（CGA-HaH）是老年人传统住院中级护理的可行替代方案，具有在家度过时间增加等相关优势，且死亡率没有上升。
