Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment

Carme Hernández; Jesus Aibar; Nuria Seijas; Imma Puig; Albert Alonso; Judith Garcia-Aymerich; Josep Roca

doi:10.5334/ijic.3431

Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment

International Journal of Integrated Care

Volume 18 (2018): Issue 2

By: Carme Hernández , Jesus Aibar, Nuria Seijas, Imma Puig, Albert Alonso, Judith Garcia-Aymerich and Josep Roca

Open Access

|May 2018

Abstract

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored.

Objective: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona.

Methods: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients’ and professionals’ perspectives, technologies and costs were evaluated.

Results: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0–3) days and the length of home-based stay was 6 (5–7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services.

Conclusions: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.

References

Leff, B, Burton, L, Mader, SL, Naughton, B, Burl, J, Inouye, SK, Greenough, WB, III, Guido, S, Langston, C, Frick, KD, Steinwachs, D and Burton, JR. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med, 2005; 143: 798–808. DOI: 10.7326/0003-4819-143-11-200512060-00008
Open DOI Search in Google Scholar Back to article
Caplan, GA, Sulaiman, NS, Mangin, DA, Aimonino, RN, Wilson, AD and Barclay, L. A meta-analysis of “hospital in the home”. Med J Aust, 2012; 197: 512–519. DOI: 10.5694/mja12.10480
Open DOI Search in Google Scholar Back to article
Cryer, L, Shannon, SB, Van, AM and Leff, B. Costs for ‘hospital at home’ patients were 19 percent lower, with equal or better outcomes compared to similar inpatients. Health Aff (Millwood), 2012; 31: 1237–1243. 31/6/1237 [pii]. DOI: 10.1377/hlthaff.2011.1132
Open DOI Search in Google Scholar Back to article
Jacobs, JM, Hammerman-Rozenberg, R and Stessman, J. Home hospitalization: 15 years of experience. Ann Intern Med, 2006; 144: 456. 144/6/456 [pii].
Search in Google Scholar Back to article
Jacobs, JM, Cohen, A, Rozengarten, O, Meiller, L, Azoulay, D, Hammerman-Rozenberg, R and Stessman, J. Closure of a home hospital program: impact on hospitalization rates. Arch Gerontol Geriatr, 2007; 45: 179–189. S0167-4943(06)00107-5 [pii]. DOI: 10.1016/j.archger.2006.10.009
Open DOI Search in Google Scholar Back to article
Montalto, M. The 500-bed hospital that isn’t there: the Victorian Department of Health review of the Hospital in the Home program. Med J Aust, 2010; 193: 598–601. mon10237_fm [pii].
Search in Google Scholar Back to article
Shepperd, S, Iliffe, S, Doll, HA, Clarke, MJ, Kalra, L, Wilson, AD and Goncalves-Bradley, DC. Admission avoidance hospital at home. Cochrane Database Syst Rev, 2016; 9. DOI: 10.1002/14651858.CD007491.pub2
Open DOI Search in Google Scholar Back to article
[Anonymous]. Pla de Salut Generalitat de Catalunya 2011–2015; 2015. http://salutweb.gencat.cat/web/.content/home/el_departament/pla_de_salut/documents/arxius/health_plan_english.pdf.
Search in Google Scholar Back to article
Wagner, EH, Austin, BT and Von, KM. Organizing care for patients with chronic illness. Milbank Q, 1996; 74: 511–544. DOI: 10.2307/3350391
Open DOI Search in Google Scholar Back to article
Wagner, EH, Austin, BT, Davis, C, Hindmarsh, M, Schaefer, J and Bonomi, A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood), 2001; 20: 64–78. DOI: 10.1377/hlthaff.20.6.64
Open DOI Search in Google Scholar Back to article
Barberan-Garcia, A, Vogiatzis, I, Solberg, HS, Vilaro, J, Rodriguez, DA, Garasen, HM, Troosters, T, Garcia-Aymerich, J and Roca, J. Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries. Respir Med, 2014; 108: 628–637. S0954-6111(13)00492-7 [pii]. DOI: 10.1016/j.rmed.2013.12.006
Open DOI Search in Google Scholar Back to article
Hernandez, C, Alonso, A, Garcia-Aymerich, J, Serra, I, Marti, D, Rodriguez-Roisin, R, Narsavage, G, Carmen, GM and Roca, J. Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial. NPJ Prim Care Respir Med, 2015; 25: 15022. [pii]. DOI: 10.1038/npjpcrm.2015.22
Open DOI Search in Google Scholar Back to article
Burgos, F, Melia, U, Vallverdú, M, Velickovski, F, Lluch-Ariet, M, Caminal, P and Roca, J. Clinical Decision Support System to Enhance Quality Control of Spirometry using Information and Communication Technologies. JMIR Med Inform, 2014; 2(2): e29. DOI: 10.2196/medinform.3179
Open DOI Search in Google Scholar Back to article
Burgos, F, Disdier, C, de Santamaria, E, Galdiz, B, Roger, N, Rivera, ML, Hervas, R, Duran-Tauleria, E, Garcia-Aymerich, J and Roca, J. Telemedicine enhances quality of forced spirometry in primary care. Eur Respir J, 2012; 39: 1313–1318. [pii]. DOI: 10.1183/09031936.00168010
Open DOI Search in Google Scholar Back to article
Hernandez, C. Deployment of Integrated Care Services for Chronic Patients Supported by Information and Communication Technologies. The NEXES project. Doctoral Thesis. 2015; University of Barcelona [dissertation].
Search in Google Scholar Back to article
Hernandez, C, Alonso, A, Garcia-Aymerich, J, Grimsmo, A, Vontetsianos, T, Garcia, CF, Altes, AG, Vogiatzis, I, Garasen, H, Pellise, L, Wienhofen, L, Cano, I, Meya, M, Moharra, M, Martinez, JI, Escarrabill, J and Roca, J. Integrated care services: lessons learned from the deployment of the NEXES project. Int J Integr Care, 2015; 15: e006. DOI: 10.5334/ijic.2018
Open DOI Search in Google Scholar Back to article
Casas, A, Troosters, T, Garcia-Aymerich, J, Roca, J, Hernandez, C, Alonso, A, del, PF, de, TP, Anto, JM, Rodriguez-Roisin, R and Decramer, M. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J, 2006; 28: 123–130. DOI: 10.1183/09031936.06.00063205
Open DOI Search in Google Scholar Back to article
Garcia-Aymerich, J, Hernandez, C, Alonso, A, Casas, A, Rodriguez-Roisin, R, Anto, JM and Roca, J. Effects of an integrated care intervention on risk factors of COPD readmission. Respir Med, 2007; 101: 1462–1469. DOI: 10.1016/j.rmed.2007.01.012
Open DOI Search in Google Scholar Back to article
Hernandez, C, Casas, A, Escarrabill, J, Alonso, J, Puig-Junoy, J, Farrero, E, Vilagut, G, Collvinent, B, Rodriguez-Roisin, R and Roca, J. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J, 2003; 21: 58–67. DOI: 10.1183/09031936.03.00015603
Open DOI Search in Google Scholar Back to article
Patsopoulos, NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci, 2011; 13: 217–224.
Search in Google Scholar Back to article
Leff, B and Montalto, M. Home hospital-toward a tighter definition. J Am Geriatr Soc, 2004; 52: 2141. DOI: 10.1111/j.1532-5415.2004.52579_1.x
Open DOI Search in Google Scholar Back to article
Shepperd, S, Doll, H, Angus, RM, Clarke, MJ, Iliffe, S, Kalra, L, Ricauda, NA and Wilson, A. Hospital at home admission avoidance (Review); 2011.
Search in Google Scholar Back to article
Goncalves-Bradley, DC, Iliffe, S, Doll, HA, Broad, J, Gladman, J, Langhorne, P, Richards, SH and Shepperd, S. Early discharge hospital at home. Cochrane Database Syst Rev, 2017; 6. DOI: 10.1002/14651858.CD000356.pub4
Open DOI Search in Google Scholar Back to article
Fetter, RB, Shin, Y, Freeman, JL, Averill, RF and Thompson, JD. Case mix definition by diagnosis-related groups. Med Care, 1980; 18: iii,1–iii,53.
Search in Google Scholar Back to article
Cano, I, Alonso, A, Hernandez, C, Burgos, F, Barberan-Garcia, A, Roldan, J and Roca, J. An adaptive case management system to support integrated care services: Lessons learned from the NEXES project. J Biomed Inform, 2015; 55: 11–22. S1532-0464(15)00045-3 [pii]. DOI: 10.1016/j.jbi.2015.02.011
Open DOI Search in Google Scholar Back to article
Roca, J. The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital. QJM, 2009; 102: 193–202. DOI: 10.1093/qjmed/hcn172
Open DOI Search in Google Scholar Back to article
Mahoney, FI and Barthel, DW. Functional evaluation: The Barthel Index. Md State Med J, 2013 [1965]; 14: 61–65.
Search in Google Scholar Back to article
Vilagut, G, Ferrer, M, Rajmil, L, Rebollo, P, Permanyer-Miralda, G, Quintana, JM, Santed, R, Valderas, JM, Ribera, A, Domingo-Salvany, A and Alonso, J. The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments. Gac Sanit, 2005; 19: 135–150. 13074370 [pii].
Search in Google Scholar Back to article
WHO. Adherence to Long-term Therapies. Evidence for Action; 2003. http://www.who.int/chp/knowledge/publications/adherence_report/en/index.html.
Search in Google Scholar Back to article
Mompart, A, Medina, A, Guillén, M, Alcañiz, M and Brugulat, P. Características metodológicas de la Encuesta de Salud de Cataluña 2006. Medicina Clínica, 2011; 137(2): 3–8. http://www.sciencedirect.com/science/article/pii/S0025775311700215. DOI: 10.1016/S0025-7753(11)70021-5
Open DOI Search in Google Scholar Back to article
Kidholm, K, Ekeland, AG, Jensen, LK, Rasmussen, J, Pedersen, CD, Bowes, A, Flottorp, SA and Bech, M. A model for assessment of telemedicine applications: MAST. Int J Technol Assess Health Care, 2012; 28: 44–51. [pii]. DOI: 10.1017/S0266462311000638
Open DOI Search in Google Scholar Back to article
Coleman, EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc, 2003; 51: 549–555. jgs51185 [pii].
Search in Google Scholar Back to article
Coleman, EA, Parry, C, Chalmers, S and Min, SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med, 2006; 166: 1822–1828. 166/17/1822 [pii]. DOI: 10.1001/archinte.166.17.1822
Open DOI Search in Google Scholar Back to article
Coleman, EA, Parry, C, Chalmers, SA, Chugh, A and Mahoney, E. The central role of performance measurement in improving the quality of transitional care. Home Health Care Serv Q, 2007; 26: 93–104. DOI: 10.1300/J027v26n04_07
Open DOI Search in Google Scholar Back to article
Naylor, MD, Brooten, D, Campbell, R, Jacobsen, BS, Mezey, MD, Pauly, MV and Schwartz, JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA, 1999; 281: 613–620. joc80991 [pii].
Search in Google Scholar Back to article
Naylor, MD. Transitional care for older adults: a cost-effective model. LDI Issue Brief, 2004; 9: 1–4.
Search in Google Scholar Back to article
Naylor, MD, Aiken, LH, Kurtzman, ET, Olds, DM and Hirschman, KB. The care span: The importance of transitional care in achieving health reform. Health Aff (Millwood), 2011; 30: 746–754. 30/4/746 [pii]. DOI: 10.1377/hlthaff.2011.0041
Open DOI Search in Google Scholar Back to article
D’Souza, S and Guptha, S. Preventing admission of older people to hospital. BMJ, 2013; 346. DOI: 10.1136/bmj.f3186
Open DOI Search in Google Scholar Back to article
Hansen, LO, Young, RS, Hinami, K, Leung, A and Williams, MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med, 2011; 155: 520–528. 155/8/520 [pii]. DOI: 10.7326/0003-4819-155-8-201110180-00008
Open DOI Search in Google Scholar Back to article
Rennke, S, Nguyen, OK, Shoeb, MH, Magan, Y, Wachter, RM and Ranji, SR. Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Ann Intern Med, 2013; 158: 433–440. 1656449 [pii]. DOI: 10.7326/0003-4819-158-5-201303051-00011
Open DOI Search in Google Scholar Back to article
Buurman, BM. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff (Millwood), 2014; 33: 1531–1539. 33/9/1531 [pii]. DOI: 10.1377/hlthaff.2014.0160
Open DOI Search in Google Scholar Back to article
Frenk, J, Chen, L, Bhutta, ZA, Cohen, J, Crisp, N, Evans, T, Fineberg, H, Garcia, P, Ke, Y, Kelley, P, Kistnasamy, B, Meleis, A, Naylor, D, Pablos-Mendez, A, Reddy, S, Scrimshaw, S, Sepulveda, J, Serwadda, D and Zurayk, H. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet, 2010; 376: 1923–1958. [pii]. DOI: 10.1016/S0140-6736(10)61854-5
Open DOI Search in Google Scholar Back to article
Auerbach, AD, Patel, MS, Metlay, JP, Schnipper, JL, Williams, MV, Robinson, EJ, Kripalani, S and Lindenauer, PK. The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care. Acad Med, 2014; 89: 415–420. DOI: 10.1097/ACM.0000000000000139
Open DOI Search in Google Scholar Back to article
Peters, DH, Adam, T, Alonge, O, Agyepong, IA and Tran, N. Implementation research: what it is and how to do it. BMJ, 2013; 347: f6753.
Search in Google Scholar Back to article
Duenas-Espin, I, Vela, E, Pauws, S, Bescos, C, Cano, I, Cleries, M, Contel, JC, de Manuel, KE, Garcia-Aymerich, J, Gomez-Cabrero, D, Kaye, R, Lahr, MM, Lluch-Ariet, M, Moharra, M, Monterde, D, Mora, J, Nalin, M, Pavlickova, A, Piera, J, Ponce, S, Santaeugenia, S, Schonenberg, H, Stork, S, Tegner, J, Velickovski, F, Westerteicher, C and Roca, J. Proposals for enhanced health risk assessment and stratification in an integrated care scenario. BMJ Open, 2016; 6: e010301. bmjopen-2015-010301 [pii]. DOI: 10.1136/bmjopen-2015-010301
Open DOI Search in Google Scholar Back to article
Siu, AL, Spragens, LH, Inouye, SK, Morrison, RS and Leff, B. The ironic business case for chronic care in the acute care setting. Health Aff (Millwood), 2009; 28: 113–125. 28/1/113 [pii]. DOI: 10.1377/hlthaff.28.1.113
Open DOI Search in Google Scholar Back to article
Sherman, RE, Anderson, SA, Dal Pan, GJ, Gray, GW, Gross, T, Hunter, NL, LaVange, L, Marinac-Dabic, D, Marks, PW, Robb, MA, Shuren, J, Temple, R, Woodcock, J, Yue, LQ and Califf, RM. Real-World Evidence – What Is It and What Can It Tell Us? N Engl J Med, 2016; 375: 2293–2297. DOI: 10.1056/NEJMsb1609216
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/ijic.3431 | Journal eISSN: 1568-4156

Journal RSS Feed

Language: English

Submitted on: Sep 18, 2017

Accepted on: Apr 18, 2018

Published on: May 16, 2018

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Home Hospitalization,

© 2018 Carme Hernández, Jesus Aibar, Nuria Seijas, Imma Puig, Albert Alonso, Judith Garcia-Aymerich, Josep Roca, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2018): Issue 2