Figure 1
Flow chart of the study. *Other circumstances (marginal social condition, severe psychiatric disorder and lack of health insurance). See on line supplement for classification of diagnoses and clustering by diagnostic group.
Table 1
General characteristics of discharges.
| Episodes, n | Total n = 4,165 | HH n = 2,529 (61%) | ED n = 1,636 (39%) | p value | |
|---|---|---|---|---|---|
| Socio-Demographic (patient interview) | |||||
| Age (yrs), m ± SD | 71 ± 15 | 73 ± 15 | 69 ± 14 | <0.001 | * |
| Women, m ± SD | 1,563(38) | 1,011(40) | 552(34) | <0.001 | ¥ |
| Health Care resources (patient interview and clinical record) | |||||
| Home care prior admision | |||||
| Primary Care, n(%) | 393(9) | 278(11) | 115(7) | <0.001 | ¥ |
| Palliative care, n(%) | 58(1) | 38(2) | 20(1) | 0.440 | ¥ |
| Hospital, n(%) | 107(3) | 80(3) | 27(2) | 0.002 | ¥ |
| Without any suppot at home, n(%) | 3,607(87) | 2,133(84) | 1,474(90) | <0.001 | ¥ |
| Hospital resources in previous 12 m | |||||
| Visits to ER, (Median, P25–P75) m ± SD | 0(0–1) 1 ± 1 | 0(0–1) 0.8 ± 1 | 0(0–1) 0.7 ± 1 | <0.001 | * |
| Hospital admissions, (Median, P25–P75) | 0(0–1) 1 ± 1 | 0(0–1) 0.8 ± 1 | 0(0–1) 0.7 ± 1 | 0.001 | * |
| Chronic conditions (clinical record) | |||||
| >1 chronic conditions, n(%) | 3,184(76) | 1 958(77) | 1,226(75) | 0.043 | ¥ |
| n° of comorbidities, m ± SD | 4 ± 3 | 4 ± 3 | 4 ± 2 | <0.001 | * |
| Charlson Index, m ± SD | 4 ± 3 | 5 ± 3 | 4 ± 3 | <0.001 | * |
| Main Diagnóstic Group, n(%) | |||||
| Respiratory n(%) | 1,474(35) | 1,018(40) | 456(28) | <0.001 | * |
| Cardiology n(%) | 1,203(29) | 367(15) | 85(5) | <0.001 | * |
| Post-surgery n(%) | 705(17) | 20(1) | 695(42) | <0.001 | * |
| Oncology n(%) | 452(11) | 260(10) | 71(4) | <0.001 | * |
| Acute illness n(%) | 331(8) | 864(34) | 339(21) | <0.001 | * |
| Risk factors and treatments (patient iterview and clinic record) | |||||
| Smoking (pack/yr) (Median, P25–P75) | (n = 1,651) 37(15–60) | (n = 948) 36(14–60) | (n = 703) 37(15–60) | 0.917 | * |
| Active smoker, n(%) | 557(13) | 303(12) | 254(16) | 0.001 | ¥ |
| Ex-smoker, n(%) | 1,898(46) | 1,151(46) | 747(46) | 0.948 | ¥ |
| BMI, m ± SD | (n = 3,087) 27 ± 5 | (n = 1,841) 27 ± 5 | (n = 1,246) 27 ± 5 | 0.593 | * |
| Sedentary lifestyle, n(%) | 1,038(25) | 739(30) | 299(19) | <0.001 | |
| Treatment prior admission | |||||
| Oxygen therapy at home, n(%) | 453(11) | 300(12) | 153(9) | 0.156 | |
| CPAP/BIPAP, n(%) | 171(4) | 105(4) | 66(4) | 0.298 | |
| n° pills/day, m ± SD | 6 ± 5 | 6 ± 5 | 5 ± 4 | <0.001 | * |
| n° inhalations/day, m ± SD | 1.9 ± 3.3 | 2.2 ± 3.4 | 1.6 ± 3.1 | <0.001 | * |
| Knowledge of chronic disease | |||||
| Name of disease, n(%) | (n = 3,846) 2,049(53) | n = 2,332 1,210(52) | n = 1,532 839(55) | 0.080 | ¥ |
| Alarm signs + had an action plan, n(%) | (n = 3,816) 1,492(39) | n = 2,325 890(38) | n = 1,521 602(40) | 0.419 | ¥ |
| Difficulty in treatment delivery, n(%) | (n = 3,816) 274(7) | n = 2,314 185(8) | n = 1,502 89(6) | 0.02 | ¥ |
| Patient’s dependence factors (self-administrated questionnaires) | |||||
| Quality of life (SF-36) | |||||
| Physical status, m ± SD | 33 ± 13 | 32 ± 13 | 34 ± 12 | 0.053 | * |
| Mental status, m ± SD | 41 ± 16 | 41 ± 16 | 42 ± 15 | 0.097 | * |
| Daily life activities (Barthel Index), (Median, P25–P75) | (n = 4,107) 89 ± 21 100(85–100) | (n = 2,501) 87 ± 23 100(85–100) | (n = 1,606) 91 ± 18 100(90–100) | <0.001 | * |
| Mild dependence, n(%) | 921(22) | 597(24) | 324(20) | 0.006 | ¥ |
| Independent, n(%) | 2,487(61) | 1,427(57) | 1,060(66) | <0.001 | ¥ |
[i] Legend: Data are expressed as mean ± standard deviation for quantitative variables and number (percentage) for discrete variables. It is expressed as median (25–75th Percentile) in quantitative variables with extreme values. ¥Chi2 test or Fisher’s exact test were used for the comparison of proportions. Indicates statistical significant differences between the two groups. *The Mann-Whitmey U test was used for variables not normally distributed. Home Hospitalization (HH), Early Discharge (ED), Emergency Room Department (ER), Body Mass Index (BMI), Continuous Positive Airway Pressure (CPAP), Bilevel positive airway pressure (BIPAP), The Short Form (36) Health Survey (SF-36).
Table 2
Comparisons between the study group (Home Hospitalization/Early Discharge).
| Variable | Total | HH | ED | p value | |
|---|---|---|---|---|---|
| n° discharge | 4,165 | 2,529 | 1,636 | ||
| In-Hospital stay, days | |||||
| Hospital stay (Median, P25–P75) | 1(0–3) | 0(0–1) | 4(2–7) | <0.001 | * |
| Home stay, days | |||||
| Home stay (Median, P25–P75) | 6(5–7) | 6(5–7) | 5(4–7) | <0.001 | * |
| Total length of stay, days | |||||
| In-hospital + Home (Median, P25–P75) | 7(6–10) | 6(5–8) | 10(8–14) | <0.001 | * |
| Use of resources during HH/ED | |||||
| Number of Physician visits, m ± SD | 1 ± 0.5 | 0.85 ± 0.46 | 0.85 ± 0.43 | 0.735 | * |
| Number of nurse visits, m ± SD | 7 ± 3 | 6.6 ± 2.8 | 6.5 ± 3.6 | <0.001 | * |
| Number phone call to the patient, m ± SD | 2 ± 1 | 2 ± 1 | 2 ± 1 | 0.903 | |
| Emergency Room visits, n(%) | 68(2) | 45(2) | 23(1) | 0.353 | ¥ |
| In-Hospital re-admissions, n(%) | 201(5) | 127(5) | 74(4) | 0.463 | ¥ |
| Outcomes at 30 days after HH/ED discharge | |||||
| Emergency Room visits, n(%) | 311(7) | 181(7) | 130(8) | 0.448 | ¥ |
| Hospital admissions, n(%) | 461(11) | 288(11) | 173(11) | 0.441 | ¥ |
| Mortality | |||||
| During episode, n(%) | 12(0.3) | 10(0 4) | 2(0.1) | 0.108 | ¥ |
| During 30 days post discharge, n(%) | 94(2) | 73(3) | 21(1) | 0.001 | ¥ |
| Transitional Care after HH/ED discharge | |||||
| Primary care n(%) | 3,527(85) | 2,077(82) | 1,450(89) | <0.001 | * |
| Palliative care n(%) | 226(5) | 156(6) | 70(4) | <0.001 | * |
| Hospital n(%) | 292(7) | 215(8) | 77(5) | <0.001 | * |
[i] Legend: Data are expressed as mean ± standard deviation for quantitative variables and number (percentage) for discrete variables. It is expressed as median (25–75th Percentile) in quantitative variables showing extreme values. ¥Chi2 test or Fisher’s exact test were used for the comparison of proportions. Indicates statistical significant differences between the two groups. *The Mann-Whitmey U test was used for variables not normally distributed. Home Hospitalization (HH), Early Discharge (ED).
Table 3
Unadjusted and Adjusted Regression Model, 30 days after Home Hospitalization/Early Discharge.
| HH/ED | HH (<24 h) | ED (>24 h) | ||
|---|---|---|---|---|
| Unadjusted ORs (CI95%) p value | Adjusted Ors (CI95%) p value | Adjusted Ors (CI95%) p value | Adjusted Ors (CI95%) p value | |
| Age (yrs) | 0.765(0.622–0.940) p = 0.011 | |||
| Gender (women) | 0.765(0.622–0.940) p = 0.011 | |||
| Charlson Index ≥3 points | 3.145(2.185–4.527) p = 0.001 | 3.247(1.723–5.503) p < 0.001 | 2.945(1.160–7.474) p = 0.023 | 3.448(1.323–8.900) p = 0.011 |
| n comorbidities >1 | 1.480(1.151–1.903) p = 0.002 | |||
| Daily physical activity | 0.678(0.549–0.837) p < 0.001 | |||
| Dependency (Barthel Index) | 1.519(1.249–1.849) p < 0.001 | 1.648(1.190–2.281) p = 0.003 | 1.751(1.145–2.678) p = 0.010 | |
| Previous Hospital admission (12 m) | 1.285(1.209–1.365) p < 0.001 | 1.218(1.098–2.010) p = <0.001 | 1.308(1.138–1.503) p < 0.001 | |
| LTOT | 1.414(1.066–1.877) p = 0.016 | |||
| Heart Failure | 2.092(1.616–2.707) p < 0.001 | 2.000(1.325–3.020) p = 0.001 | 2.126(1.324–3.414) p = 0.002 | |
| Post-surgery | 0.755(0.571–0.989) p = 0.048 | |||
| Oncology | 1.984(1.477–2.665) p < 0.001 | 2.510(1.152–5.029) p = 0.009 | ||
| SF-36 physical domain | 0.977(0.967–0.998) p < 0.001 | |||
| n Pills/day | 1.073(1.052–10.96) p < 0.001 | 1.070(1.010–1.132) p = 0.021 | ||
| Palliative care | 1.920(0.988–3.729) p = 0.052 | 5.525(1.025–10.25) p = 0.006 | ||
| Intervention (HH/ED) | 0.920(0.754–1.124) p = 0.414 | NA | NA | |
[i] Legend: Long Term Oxygen Therapy (LTOT); The Short Form (36) Health Survey (SF-36); Home Hospitalization (HH), Early Discharge (ED).