Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad

Outcomes and costs of home hospitalisation compared to traditional hospitalisation for infectious diseases in Israel: a cohort study

OBJECTIVES

This study aims to evaluate and compare health outcomes and costs between home hospitalisation and traditional hospitalisation for three common diagnoses-cellulitis, urinary tract infection (UTI) and pneumonia.

DESIGN

A retrospective cohort study.

SETTING

Primary care, nationwide.

PARTICIPANTS

1311 patients in home hospitalisation and 992 in traditional hospitalisation.

INTERVENTIONS

The primary intervention is home hospitalisation, compared with traditional hospitalisation. The intervention was performed according to medical considerations by a specialised team, and this study was done retrospectively to evaluate it.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary measures included healthcare costs, length of hospitalisation, referrals for further medical services and mortality.

RESULTS

Costs of home hospitalisation were lower compared with traditional hospitalisation (6056 vs 9619 NIS for pneumonia, 6011 vs 9767 NIS for cellulitis, 6466 vs 8552 NIS for UTI and p value<0.05). The length of home hospitalisations was shorter for pneumonia and cellulitis (5.01 vs 6.05 days, p value 0.001 and 5.3 vs 6.1 days, p value<0.001, respectively). Likewise, for pneumonia and cellulitis, home-hospitalised patients had fewer ED referrals 30 days after discharge (13.7% vs 24%, p value<0.001 and 13.5% vs 19.8%, p value 0.002, respectively). No differences were found in recurrent hospitalisation and mortality 7 and 30 days after discharge.

CONCLUSIONS

Primary care physicians should consider home hospitalisation for these diagnoses as an alternative to traditional hospitalisation. Policymakers should encourage Primary care physicians to use home hospitalisation, as it has financial advantages and better health outcomes.

Management of COPD in a Hospital-at-Home Setting at a Peripheral Spanish Hospital: 8-Year Experience

We performed exploratory and descriptive analyses of data from our 8 years of experience in hospital-at-home (HaH) treatment to characterize the clinical profile of patients with exacerbated underlying chronic obstructive pulmonary disease (COPD). Our study had a retrospective research design, using historical electronic health records from patients admitted to the HaH setting between 2012 and 2019. We collected demographic, administrative, and clinical data from patients diagnosed with exacerbated COPD. Between 2012 and 2019, 420 patients diagnosed with acute respiratory infectious disease related to COPD were treated in our HaH setting (18% of all admissions to HaH). Most patients were referred from the Internal Medicine Department. The median length of the hospital stay was 10 days. Most patients (78.8%) presented acute exacerbation with no pneumonia. One-third of the patients required domiciliary oxygen therapy, and half required ventilatory devices for nebulized bronchodilator therapy. All patients were successfully discharged as clinically stable. Our HaH experience in managing patients with exacerbated COPD indicates a means of obtaining cost savings and increased quality of life for patients in which antibiotic and ventilatory therapy is not compromised.

Infective Endocarditis in a Hospital-at-Home Setting: A Retrospective Analysis in a Peripheral Spanish Hospital

Infective endocarditis (IE) is a severe condition with high morbidity and mortality, and it requires long-term suppressive antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been used for a range of infectious diseases for more than 30 years, and in Spain it is used in hospital-at-home (HaH) settings. Our objectives were to describe and characterize the demographic, clinical, and microbiological features of patients admitted to an HaH setting and to assess the safety and effectiveness of OPAT. We conducted a retrospective study that included patients diagnosed with IE over a period of 8 years (2011-2018). We collected demographic and clinical features, length of hospital stay, antimicrobial treatment, microbiological profiles, and outcomes. We included 26 patients during the observation period. Their mean age was 66.5 years, and 88.5% were male. The mean hospital stay was 10.5 days, and the mean stay in the HaH setting was 31 days. A total of 6 patients required readmission due to deterioration, of whom 3 had severe mitral insufficiency. The 8 patients had symptoms of heart failure, but they were treated at home and did not require readmission. Ultimately, 12 patients recovered and were referred to a surgical unit for valvular repair and replacement on a scheduled basis. OPAT is a useful and effective tool for the management of patients diagnosed with IE in HaH settings.

The Comfort Theory as a Theoretical Framework Applied to a Clinical Case of Hospital at Home

The comfort theory was applied in the development of a nursing process for the clinical case of an older adult with pneumonia treated under hospital at home. It was observed that the theory is easy to apply in the domiciliary context and that it allows the implementation of a holistic care plan.

When, where and how should a patient with community acquired pneumonia be admitted?

Community-acquired pneumonia is the leading cause of death (10-14%) from infectious disease and the source of many sepsis and septic shock cases attended in the emergency departments. There is great variability in the admission rates (22-61%), and 10-20% of such admissions have to be done in the intensive care unit. The correct determination of need for admission (when), admission site (where) and burden of delivered care (how) will determine the patient's prognosis, request for basic and microbiological studies, antibiotic regimen (via and duration), clinical follow-up intensity and, consequently, the use of socio-health resources (costs). This article aims to orient decision-making, taking into account the new trends in prognostic evaluation tendencies and the current alternatives to the classic hospital admission.