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Seijas V, Maritz R, Fernandes P, Bernard RM, Lugo LH, Bickenbach J, Sabariego C. Rehabilitation delivery models to foster healthy ageing-a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1307536. [PMID: 38660395 PMCID: PMC11041397 DOI: 10.3389/fresc.2024.1307536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Introduction Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.
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Affiliation(s)
- Vanessa Seijas
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roxanne Maritz
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Patricia Fernandes
- Department of Clinical Medicine, Federal University of Parana, Parana, Brazil
| | | | - Luz Helena Lugo
- Rehabilitation in Health Research Group, University of Antioquia, Medellin, Colombia
| | - Jerome Bickenbach
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Carla Sabariego
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Punchik B, Kolushev-Ivshin I, Kagan E, Lerner E, Velikiy N, Marciano S, Freud T, Golan R, Cohn-Schwartz E, Press Y. The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel. Isr J Health Policy Res 2024; 13:8. [PMID: 38355553 PMCID: PMC10865532 DOI: 10.1186/s13584-024-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND A model of hospital-at-home services called the Home Care Unit ("the unit") has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model. METHODS A retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit. RESULTS The study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001). CONCLUSIONS Treatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.
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Affiliation(s)
- Boris Punchik
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel.
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ilona Kolushev-Ivshin
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Kagan
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Ella Lerner
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Natalia Velikiy
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Suzann Marciano
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rachel Golan
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Cohn-Schwartz
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Chen H, Ignatowicz A, Skrybant M, Lasserson D. An integrated understanding of the impact of hospital at home: a mixed-methods study to articulate and test a programme theory. BMC Health Serv Res 2024; 24:163. [PMID: 38308304 PMCID: PMC10835828 DOI: 10.1186/s12913-024-10619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Hospital at Home (HaH) provides intensive, hospital-level care in patients' homes for acute conditions that would normally require hospitalisation, using multidisciplinary teams. As a programme of complex medical-social interventions, a HaH programme theory has not been fully articulated although implicit in the structures, functions, and activities of the existing HaH services. We aimed to unearth the tacit theory from international evidence and test the soundness of it by studying UK HaH services. METHODS We conducted a literature review (29 articles) adopting a 'realist review' approach (theory articulation) and examined 11 UK-based services by interviewing up to 3 staff members from each service (theory testing). The review and interview data were analysed using Framework Analysis and Purposive Text Analysis. RESULTS The programme theory has three components- the organisational, utilisation and impact theories. The impact theory consists of key assumptions about the change processes brought about by HaH's activities and functions, as detailed in the organisational and utilisation theories. HaH teams should encompass multiple disciplines to deliver comprehensive assessments and have skill sets for physically delivering hospital-level processes of care in the home. They should aim to treat a broad range of conditions in patients who are clinically complex and felt to be vulnerable to hospital acquired harms. Services should cover 7 days a week, have plans for 24/7 response and deliver relational continuity of care through consistent staffing. As a result, patients' and carers' knowledge, skills, and confidence in disease management and self-care should be strengthened with a sense of safety during HaH treatment, and carers better supported to fulfil their role with minimal added care burden. CONCLUSIONS There are organisational factors for HaH services and healthcare processes that contribute to better experience of care and outcomes for patients. HaH services should deliver care using hospital level processes through teams that have a focus on holistic and individually tailored care with continuity of therapeutic relationships between professionals and patients and carers resulting in less complexity and fragmentation of care. This analysis informs how HaH services can organise resources and design processes of care to optimise patient satisfaction and outcomes.
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Affiliation(s)
- Hong Chen
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK
| | - Agnieszka Ignatowicz
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TTT, UK
| | - Magdalena Skrybant
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TTT, UK
| | - Daniel Lasserson
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK.
- Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Chen H, Ignatowicz A, Lasserson DS. The Essentials for Implementing and Operating Hospital at Home: Lessons Learned from UK Health Care Professionals. J Am Med Dir Assoc 2024; 25:279-281. [PMID: 38122826 DOI: 10.1016/j.jamda.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Hong Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Agnieszka Ignatowicz
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Daniel S Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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Moldovan F, Moldovan L. Assessment of Patient Matters in Healthcare Facilities. Healthcare (Basel) 2024; 12:325. [PMID: 38338210 PMCID: PMC10855928 DOI: 10.3390/healthcare12030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities. MATERIALS AND METHODS We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile. RESULTS We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures. CONCLUSIONS Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Lloyd-Sherlock P, Fialho de Carvalho P, Giacomin K, Sempé L. Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study. LANCET REGIONAL HEALTH. AMERICAS 2023; 27:100619. [PMID: 37954965 PMCID: PMC10632531 DOI: 10.1016/j.lana.2023.100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Abstract
Background In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Methods Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings The data reveal three theories of change. Theory 1 is PMC maintains older people's health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services. Funding Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.
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Affiliation(s)
- Peter Lloyd-Sherlock
- School of International Development, University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | | | - Karla Giacomin
- Fundação Cuidadosa, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Sempé
- Queen Margaret University, Edinburgh, United Kingdom
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Moldovan F, Moldovan L, Bataga T. Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040796. [PMID: 37109755 PMCID: PMC10143905 DOI: 10.3390/medicina59040796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Quality Engineering Research Center, Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Lee MC, Wu TY, Huang SJ, Chen YM, Hsiao SH, Tsai CY. Post-acute care for frail older people decreases 90-day emergency room visits, readmissions and mortality: An interventional study. PLoS One 2023; 18:e0279654. [PMID: 36607971 PMCID: PMC9821781 DOI: 10.1371/journal.pone.0279654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. METHODS This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. RESULTS Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10-0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16-0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04-0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17-3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53-4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16-8.63; p = 0.024). CONCLUSION PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT Identifier: NCT05452395.
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Affiliation(s)
- Min-Chang Lee
- Center for Athletic Health Management, Renai Branch, Taipei City Hospital, Taipei, Taiwan
- Center for General Education, Taipei University of Marine Technology, Taipei, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
- * E-mail:
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Renai Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Ching-Yao Tsai
- General Education Center, University of Taipei, Taipei, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
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Denecke K, May R, Borycki EM, Kushniruk AW. Digital health as an enabler for hospital@home: A rising trend or just a vision? Front Public Health 2023; 11:1137798. [PMID: 36875371 PMCID: PMC9981936 DOI: 10.3389/fpubh.2023.1137798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background Hospital@home is a model of healthcare, where healthcare professionals actively treat patients in their homes for conditions that may otherwise require hospitalization. Similar models of care have been implemented in jurisdictions around the world over the past few years. However, there are new developments in health informatics including digital health and participatory health informatics that may have an impact on hospital@home approaches. Objectives This study aims to identify the current state of implementation of emerging concepts into the hospital@home research and models of care; to identify strengths and weaknesses, opportunities, and threats associated with the models of care; and to suggest a research agenda. Methods We employed two research methodologies, namely, a literature review and a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The literature from the last 10 years was collected from PubMed using the search string "hospital at home" OR "care at home" OR "patient at home." Relevant information was extracted from the included articles. Results Title and abstract review were conducted on 1,371 articles. The full-text review was conducted on 82 articles. Data were extracted from 42 articles that met our review criteria. Most of the studies originated from the United States and Spain. Several medical conditions were considered. The use of digital tools and technologies was rarely reported. In particular, innovative approaches such as wearables or sensor technologies were rarely used. The current landscape of hospital@home models of care simply delivers hospital care in the patient's home. Tools or approaches from taking a participatory health informatics design approach involving a range of stakeholders (such as patients and their caregivers) were not reported in the literature reviewed. In addition, emerging technologies supporting mobile health applications, wearable technologies, and remote monitoring were rarely discussed. Conclusion There are multiple benefits and opportunities associated with hospital@home implementations. There are also threats and weaknesses associated with the use of this model of care. Some weaknesses could be addressed by using digital health and wearable technologies to support patient monitoring and treatment at home. Employing a participatory health informatics approach to design and implementation could help to ensure the acceptance of such care models.
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Affiliation(s)
| | - Richard May
- Harz University of Applied Sciences, Wernigerode, Germany
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
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Inzitari M, Arnal C, Ribera A, Hendry A, Cesari M, Roca S, Pérez LM. Comprehensive Geriatric Hospital at Home: Adaptation to Referral and Case-Mix Changes During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:3-9.e1. [PMID: 36470320 PMCID: PMC9647017 DOI: 10.1016/j.jamda.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the evolution of a Hospital at Home (HAH) based on comprehensive geriatric assessment (CGA), including its adaptability to changing case-mixes and pathways during the COVID-19 pandemic. DESIGN Observational study of consecutive admissions to a combined step-up (admissions from home) and step-down (hospital discharge) HAH during 3 periods: prepandemic (2018‒February 2020) vs pandemic (March‒December 2020, and January‒December 2021). SETTING AND PARTICIPANTS Participants were all consecutive patients admitted to a CGA-based HAH, located in Barcelona, Spain. Referrals followed acute events or exacerbation of chronic conditions, by either primary care (step-up) or after post-acute discharge (step-down). METHODS HAH intervention based on CGA and incorporated geriatric rehabilitation. Patient case-mix, functional evolution (Barthel index), and mortality were compared across periods and between pathways. RESULTS HAH capacity expanded 3 fold from 15 to 45 virtual beds and altogether managed 688 consecutive patients [mean age (SD) = 82.5 (9.6) years; 59% women]. Pandemic case-mix was slightly older (mean age = 83.5 vs 82 years, P = .012) than prepandemic, with greater mobility impairment. Across periods, step-up increased (26.1%, 40.9%, 48.2%, P < .01) because of medical events, skin ulcers, and post-acute stroke, whereas step-down decreased; multivariable models showed no differences in functional improvement or mortality. When comparing pathways, step-up featured older patients with higher comorbidity, worse functional status, and lower absolute functional gain than step-down (5.6 vs 13 points of Barthel index, P < .01), remaining statistically significant after adjusting for covariates (P = .003); no differences in mortality were observed. CONCLUSIONS AND IMPLICATIONS A multipurpose, step-down and step-up CGA HAH expanded its activity and adapted to changing case-mixes and pathways throughout COVID-19 pandemic waves. Although further quantitative and qualitative studies are needed to assess the impact of this model, our results suggest that harnessing the adaptability of HAH may help advance a paradigm shift toward more person-centered, cost-effective models of clinical care aimed at older adults.
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Affiliation(s)
- Marco Inzitari
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain.
| | - Cristina Arnal
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Aida Ribera
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Anne Hendry
- School of Health and Life Sciences, University of the West of Scotland, Scotland, United Kingdom
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Sílvia Roca
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain
| | - Laura Mónica Pérez
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d’Hebron Institute (VHIR), Barcelona, Spain
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11
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Mas MA, Sabaté RA, Manjón H, Arnal C. Developing new hospital-at-home models based on Comprehensive Geriatric Assessment: Implementation recommendations by the Working Group on Hospital-at-Home and Community Geriatrics of the Catalan Society of Geriatrics and Gerontology. Rev Esp Geriatr Gerontol 2023; 58:35-42. [PMID: 36635118 DOI: 10.1016/j.regg.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
Last decade, the Government of Catalonia have urged an integrated care strategy for planning the care model to older populations living with frailty, multimorbidity and advanced illnesses. Based on international evidence that was reviewed by a group of experts from the Catalan Society of Gerontology and Geriatrics, we summarised some recommendation to adapt hospital-at-home care to older populations in our system. We defined Comprehensive Geriatric Assessment (CGA) hospital-at-home (HaH) as a specialised home hospitalisation service formed by interdisciplinary teams, characterised by using the clinical methodology of CGA, and by adapting geriatric units' protocols for the provision of person-centred care at home. Main benefits of CGA-HaH in these populations are: response to heath crises according to individualised care plans based on the situational diagnosis carried out by Primary Care teams; provision of a comprehensive health and social approach tailored to the complexity of cases and situations; and adaptation of multipurpose hospitalisation, by working on different person-centred care, aspects, such as caregivers support on care provision, focusing on function or home adaptation.
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Affiliation(s)
- Miquel Angel Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain; Department of Geriatrics Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rosa Ana Sabaté
- Department of Geriatrics Parc de Salut Mar, Barcelona, Spain.
| | - Helena Manjón
- Department of Geriatrics Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Arnal
- Departament of Geriatrics Hospital Vall d'Hebron, Barcelona, Spain
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12
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Herranz C, González-Colom R, Baltaxe E, Seijas N, Asenjo M, Hoedemakers M, Nicolas D, Coloma E, Fernandez J, Vela E, Cano I, Mölken MRV, Roca J, Hernandez C. Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case. BMC Health Serv Res 2022; 22:1133. [PMID: 36071439 PMCID: PMC9454140 DOI: 10.1186/s12913-022-08496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). Methods Prospective cohort study over one year period, 2017–2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. Results HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. Conclusions We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. Registration ClinicalTrials.gov (26/04/2017; NCT03130283). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08496-z.
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Affiliation(s)
- Carme Herranz
- Consorci d'Atenció Primària de Salut de L'Eixample (CAPSBE), Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Rubèn González-Colom
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Institute of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nuria Seijas
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Asenjo
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maaike Hoedemakers
- Erasmus School of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam. Rotterdam, The Netherlands, Rotterdam, Netherlands
| | - David Nicolas
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Joaquim Fernandez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Emili Vela
- Àrea de Sistemes d'Informació. Digitalization for the Sustainability of the Healthcare System (DS3), Servei Català de La Salut, Barcelona, Spain
| | - Isaac Cano
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam. Rotterdam, The Netherlands, Rotterdam, Netherlands
| | - Josep Roca
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Carme Hernandez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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13
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Pedrosa R, Ferreira Ó, Baixinho CL. Rehabilitation Nurse’s Perspective on Transitional Care: An Online Focus Group. J Pers Med 2022; 12:jpm12040582. [PMID: 35455698 PMCID: PMC9025548 DOI: 10.3390/jpm12040582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
The increasing incidence of chronic and dependence leads to the need for hospitalization and adaptation in the process of returning home, as well as transition between care levels to ensure continuity of care. The World Health Organization has been warning about this problem since 2016, and consider reorganizing the care model as one of the solutions. The present study aimed to analyse the nurses’ perspective on transitional care for dependent people with rehabilitation care needs after hospital discharge. Methods: A focus group was developed with the participation of Rehabilitation Nurses from the hospital and community context, and content analysis was defined a posteriori. Results: From the content analysis emerged four related categories: promotion of continuity of care, nurse of advanced practice as a care manager, capacitation of the person and caregiver, and promotion of the care coordination. Conclusions: The present study allowed the strategies identification that minimize fragmentation risk of care and promote the person participation in transitional care. Ensuring transitional care is imperative to increase the quality of care, the satisfaction of professionals, clients, and the development of a system of sustainable health.
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Affiliation(s)
- Rita Pedrosa
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Correspondence:
| | - Óscar Ferreira
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal
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14
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Knight T, Lasserson D. Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population. J Intern Med 2022; 291:438-457. [PMID: 34816527 DOI: 10.1111/joim.13394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recent trends across Europe show a year-on-year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.
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Affiliation(s)
- Thomas Knight
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Foundation Trust, Birmingham, UK
| | - Daniel Lasserson
- Acute Hospital at Home, Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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15
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Røe C, Bautz-Holter E, Andelic N, Søberg HL, Nugraha B, Gutenbrunner C, Boekel A, Kirkevold M, Engen G, Lu J. Organization of rehabilitation services in randomized controlled trials - which factors influence functional outcome? A systematic review. Arch Rehabil Res Clin Transl 2022; 4:100197. [PMID: 35756983 PMCID: PMC9214333 DOI: 10.1016/j.arrct.2022.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions. Data Sources A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019. Study Selection In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0. Data Synthesis In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results. Conclusions Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.
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Affiliation(s)
- Cecilie Røe
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Corresponding author Cecilie Røe, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, P.O. Box 1089, Blidern, 0319 Oslo, Norway.
| | - Erik Bautz-Holter
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Helene Lundgaard Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | | | - Andrea Boekel
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Marit Kirkevold
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet University, Oslo, Norway
| | - Grace Engen
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia
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16
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The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people. BMC Health Serv Res 2022; 22:176. [PMID: 35144611 PMCID: PMC8831035 DOI: 10.1186/s12913-022-07552-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC - Older Person's Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. METHODS We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as 'coarsened exact matching' (CEM), 'nearest neighbor' based on logit scores (NN), 'optimal pair' (OP) and 'optimal full' (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. RESULTS We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1-1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7-6.8). Similar positive results are found across other matching methods and models. CONCLUSIONS Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.
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17
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Knight T, Harris C, Mas MÀ, Shental O, Ellis G, Lasserson D. The provision of hospital at home care: Results of a national survey of UK hospitals. Int J Clin Pract 2021; 75:e14814. [PMID: 34510673 DOI: 10.1111/ijcp.14814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hospital at home (HaH) replicates elements of hospital-based care in the community, to facilitate the safe management of a broad spectrum of acute illness in the patient's usual environment. The extent to which this model of care has been adopted in the United Kingdom is unknown. METHODS The Society for Acute Medicine Benchmarking Audit is a day of care survey undertaken annually within the United Kingdom. Participation is open to all hospital in the United Kingdom receiving acutely unwell medical patients. A questionnaire is used to collect hospital-level data on the structure and organisation of acute care delivery. The survey included questions designed to quantify the number of hospitals that offered HaH. When present, further questions were asked to clarify the characteristics of the HaH service in terms of workforce, range of diagnostic test and interventions. This information was used to build a picture of HaH service provision on a national scale. RESULTS A total of 130 hospitals contributed organisational data to SAMBA19. The capability to refer to a hospital at home service was recognised by 46.9% (n = 61) of units. The majority of these services, 83.3% (n = 50) were nurse-led. The capability to provide a physician review at home was reported in 23.3% (n = 14). The majority of services could provide intravenous antibiotics at home, but access to other simple interventions, such as intravenous diuretics or acute supplemental oxygen, is limited. CONCLUSION At present, few acute hospitals for consitency in the United Kingdom have access to a hospital at home service capable of replicating essential elements of inpatient care. Our study suggests organisational change in acute care delivery and significant investment would be required to establish equal access to hospital-at-home care within the United Kingdom.
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Affiliation(s)
- Thomas Knight
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, West Midlands, UK
| | - Ciara Harris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, West Midlands, UK
| | - Miquel À Mas
- Metropolitana Nord Chronic Care Management Team, Institut Català de la Salut, Barcelona, Catalunya, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Barcelona, Catalunya, Spain
| | | | - Graham Ellis
- Department of Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Medicine, University of Warwick, Coventry, UK
- Acute Hospital At Home, Dept of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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18
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Ohvanainen A, Niemi-Murola L, Elonheimo O, Pöyhiä R. Hospital-at-home network in Finland. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1725717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Leila Niemi-Murola
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
| | | | - Reino Pöyhiä
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
- Kauniala Hospital, Kauniainen, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
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19
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Karacaoglu K, Leask CF. Staff views of a hospital at home model implemented in a Scottish care setting. AIMS Public Health 2021; 8:467-478. [PMID: 34395696 PMCID: PMC8334636 DOI: 10.3934/publichealth.2021036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Demographic and financial challenges mean prioritising a shift in healthcare provision from acute to community settings. One well-evidenced model encapsulating this is 'hospital at home', however limited research has examined staffs' views on its implementation, which may inform service development and increase job satisfaction. The aim within was to explore the staff perspective of implementing a 'hospital at home' model in a Scottish care setting which can inform service provision and ultimately increase job satisfaction. Methods The 'Acute Care @ Home' (AC@H) service had a multi-disciplinary team. Referrals were predominantly received from a geriatric hospital ward. Inclusion criteria were older adults with geriatric syndromes and who required care input for a duration between one to seven days. In-depth staff interviews (N = 13) were conducted and analysed thematically to understand barriers and facilitators to implementation. These were supplemented with questionnaires assessing constructs of interest including training, communication and overall satisfaction. Results Several themes urged from our study: inter-team and intra-team collaboration, service development and operation, and scaling considerations. High job satisfaction was reported (mean score 73%), particularly due to a perceived non-hierarchical team structure and inclusive management style. Staff attributed positive outcomes through better identifying patients' needs at home compared to in hospital. Continuity of care facilitated rapport building. Recruitment challenges restricted the acuity and volume of patients the team were able to care for. Conclusions This qualitative methodology could be useful for future implementation of intermediate care resources for the future health and care system building. Patient assessments at home, as opposed to in hospital, in conjunction with care continuity by staff, may mitigate against hospital risks and better facilitate reablement. Where recruitment challenges are present, agile models of care delivery should be considered.
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Affiliation(s)
- Katherine Karacaoglu
- Aberdeen City Health and Social Care Partnership, Marischal College, Broad St, Aberdeen, UK.,Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, UK
| | - Calum F Leask
- Aberdeen City Health and Social Care Partnership, Marischal College, Broad St, Aberdeen, UK.,Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, UK
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20
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Sezgin D, O'Caoimh R, O'Donovan MR, Salem MA, Kennelly S, Samaniego LL, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Holditch C, Bettger JP, Vernon M, Carroll Á, Gradinger F, Perman G, Wilson M, Vella A, Cherubini A, Tucker H, Fantini MP, Onder G, Roller-Wirnsberger R, Gutiérrez-Robledo LM, Cesari M, Bertoluci P, Kieliszek M, van der Vlegel-Brouwer W, Nelson M, Mañas LR, Antoniadou E, Barriere F, Lindblom S, Park G, Pérez I, Alguacil D, Lowdon D, Alkiza ME, Bouzon CA, Young J, Carriazo A, Liew A, Hendry A. Defining the characteristics of intermediate care models including transitional care: an international Delphi study. Aging Clin Exp Res 2020; 32:2399-2410. [PMID: 32430887 DOI: 10.1007/s40520-020-01579-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. AIM To identify and define the characteristics of intermediate care models. METHODS A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. RESULTS Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. DISCUSSION There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. CONCLUSIONS This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.
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Affiliation(s)
- Duygu Sezgin
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork City, Ireland.
| | - Mark R O'Donovan
- Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | | | - Siobhán Kennelly
- Older Person's Programme, Health Service Executive, Dublin, Ireland
| | | | | | | | - Marco Inzitari
- Parc Sanitari Pere Virgili, Vall D'Hebrón Institute of Research (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | - Martin Vernon
- NHS England, London, England
- Manchester University NHS Foundation Trust, London, England
| | - Áine Carroll
- University College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dún Laoghaire, County Dublin, Ireland
| | - Felix Gradinger
- University of Plymouth, Plymouth, England
- Torbay and South Devon NHS Foundation Trust, Torbay, England
| | - Gaston Perman
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Wilson
- Raigmore Hospital Inverness NHS Highland, Inverness, Scotland
| | - Antoine Vella
- Department of Geriatric Medicine, University of Malta, Msida, Malta
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Helen Tucker
- Community Hospitals Association (UK), University of Winchester, Winchester, England
| | - Maria Pia Fantini
- Post-Graduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy
| | - Paula Bertoluci
- Alves Pereira, Public Health School, University of São Paulo (FSP/USP), São Paulo, Brazil
| | - Magdalena Kieliszek
- Center for Innovation and Technology Transfer, Medical University of Lodz, Lodz, Poland
| | | | - Michelle Nelson
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - François Barriere
- Pilote MAIA 13 Projets Parcours Pays Salonais, Pays Salonais, France
| | - Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Grace Park
- Fraser Health Authority, British Columbia, Canada
| | - Isidoro Pérez
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Dolores Alguacil
- Andalusian Health Service (Servicio Andaluz de Salud, SAS), Seville, Spain
| | | | | | | | | | - Ana Carriazo
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - Anne Hendry
- NHS Lanarkshire, Glasgow, Scotland
- University of the West of Scotland, Glasgow, Scotland
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21
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Piera-Jiménez J, Daugbjerg S, Stafylas P, Meyer I, Müller S, Lewis L, da Col P, Folkvord F, Lupiáñez-Villanueva F. BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments. JMIR Med Inform 2020; 8:e20938. [PMID: 33021490 PMCID: PMC7576466 DOI: 10.2196/20938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 09/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. OBJECTIVE The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. METHODS A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology-enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. RESULTS The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI -4.51 to 4.78; P=.95) but decreased in the comparator group (mean change -3.23, 95% CI -5.34 to -1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of -0.23 (95% CI -0.44 to -0.02; P=.03) and -0.33 (95% CI -0.46 to -0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI -0.44 to 1.01, P=.44; comparator: mean change -0.29, 95% CI -0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582). CONCLUSIONS The information and communication technology-enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. TRIAL REGISTRATION ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004.
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Affiliation(s)
- Jordi Piera-Jiménez
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Research & Development, Badalona Serveis Assistencials, Badalona, Spain
| | - Signe Daugbjerg
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Ingo Meyer
- PMV Research Group, Universität zu Köln, Köln, Germany
| | - Sonja Müller
- Empirica Gesellschaft für Kommunikations und Technologieforschung GmbH, Bonn, Germany
| | - Leo Lewis
- International Foundation for Integrated Care, Oxford, United Kingdom
| | | | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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22
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Sezgin D, O'Caoimh R, Liew A, O'Donovan MR, Illario M, Salem MA, Kennelly S, Carriazo AM, Lopez-Samaniego L, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Hendry A. The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 2020; 11:961-974. [PMID: 32754841 PMCID: PMC7402396 DOI: 10.1007/s41999-020-00365-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users. Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.,Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | | | - Maddelena Illario
- Campania Region Health Innovation Unit, and Federico II Department of Public Health, Naples, Italy
| | | | - Siobhán Kennelly
- Royal College of Surgeons in Ireland Connolly Hospital, Dublin and Health Service Executive, Dublin, Ireland
| | | | | | - Cristina Arnal Carda
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Hendry
- NHS Lanarkshire, Bothwell, UK.,School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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23
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Inzitari M, Udina C, Len O, Ars J, Arnal C, Badani H, Davey V, Risco E, Ayats P, de Andrés AM, Mayordomo C, Ros FJ, Morandi A, Cesari M. How a Barcelona Post-Acute Facility became a Referral Center for Comprehensive Management of Subacute Patients With COVID-19. J Am Med Dir Assoc 2020; 21:954-957. [PMID: 32674827 PMCID: PMC7287444 DOI: 10.1016/j.jamda.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.
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Affiliation(s)
- Marco Inzitari
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Cristina Udina
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Ars
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Arnal
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Hugo Badani
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Vanessa Davey
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ester Risco
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Pere Ayats
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ana M de Andrés
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Mayordomo
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francisco J Ros
- Medical Oncology Department, Vall d'Hebron University Hospital and, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alessandro Morandi
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Ospedale Le Ancelle, Fondazione Teresa Camplani, Cremona, Italy
| | - Matteo Cesari
- Università Statale and Policlinico Maggiore, Milan, Italy
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24
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Garrard JW, Cox NJ, Dodds RM, Roberts HC, Sayer AA. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res 2020; 32:197-205. [PMID: 30968287 PMCID: PMC7033083 DOI: 10.1007/s40520-019-01183-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
Background Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. Aim To appraise the evidence on CGA implemented within the primary care practice. Methods The review followed PRISMA recommendations. Eligible studies reported CGA on persons aged ≥ 65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed. Results The authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n = 3) or nurse practitioner (n = 1), with varied length and extent of follow-up (12–48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. Discussion The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA. Electronic supplementary material The online version of this article (10.1007/s40520-019-01183-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James W Garrard
- Radcliffe Department of Medicine, University of Oxford, Oxford, OX1 2JD, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard M Dodds
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Avan A Sayer
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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25
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Inzitari M, Risco E, Cesari M, Buurman BM, Kuluski K, Davey V, Bennett L, Varela J, Prvu Bettger J. Editorial: Nursing Homes and Long Term Care after COVID-19: A New Era? J Nutr Health Aging 2020; 24:1042-1046. [PMID: 33244558 PMCID: PMC7353831 DOI: 10.1007/s12603-020-1447-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- M Inzitari
- Marco Inzitari, Edifici Montseny 0, Parc Sanitari Pere Virgili, c Esteve Terradas 30, 08023 Barcelona, Spain, , Phone: +34 932594004
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26
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Mas MÀ, Santaeugènia SJ, Tarazona-Santabalbina FJ, Gámez S, Inzitari M. Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions. J Am Med Dir Assoc 2019; 19:860-863. [PMID: 30268290 DOI: 10.1016/j.jamda.2018.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare clinical outcomes in older patients with acute medical crises attended by a geriatrician-led home hospitalization unit (HHU) vs an inpatient intermediate-care geriatric unit (ICGU) in a post-acute care setting. DESIGN Quasi-experimental longitudinal study, with 30-day follow-up. PARTICIPANTS Older patients with chronic conditions attended at the emergency department or day hospital for an acute medical crisis. INTERVENTIONS Patients were referred to geriatrician-led HHU or ICGU wards. SETTING An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. MEASUREMENTS We compared health crisis outcomes (recovery from the acute health crisis, referral to an acute hospital, or death), length of stay, relative functional gain (RFG) at discharge, readmission to an acute care unit within 30 days of discharge, and mortality within 30 days of discharge. RESULTS We included 171 older adults (57 in the HHU and 114 in the ICGU) with complex conditions at risk of negative outcomes. At baseline, HHU patients were significantly younger and less likely to be cognitively impaired and referred from an emergency department. Most patients in both groups recovered from their health crises (91.2% in the HHU group vs 88.6% in the ICGU group, P = .79). No differences were found between the 2 groups in 30-day mortality (8.6% vs 9.6%, P = >.99). There was a trend toward lower 30-day readmission to an acute care unit in the HHU group (10.5% vs 19.3% in the ICGU group, P = .19). HHU patients had higher RFG (mean 0.75 days vs 0.51 in the ICGU group, P = .01), and a longer stay in the unit (9.7 vs 8.2 days in the ICGU group, P < .01). CONCLUSIONS These preliminary results suggest that the geriatrician-led HHU seems effective in resolving acute medical crises in older patients with chronic disease. Patients attended by the HHU obtained better functional outcomes compared to those from the ICGU, although the groups did have some baseline differences.
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Affiliation(s)
- Miquel À Mas
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia; RE-FiT bcn Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Catalonia.
| | | | - Francisco J Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Valencia, Spain; Universidad Católica de Valencia San Vicente Martir, Valencia, Spain
| | - Sara Gámez
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia
| | - Marco Inzitari
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia; Parc Sanitari Pere Virgili, Barcelona, Catalonia
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27
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Mas MÀ, Closa C, Gámez S, Inzitari M, Ribera A, Santaeugènia SJ, Gallofré M. Home as a Place for Care of the Oldest Stroke Patients: A Pilot from the Catalan Stroke Program. J Am Geriatr Soc 2019; 67:1979-1981. [PMID: 31018014 DOI: 10.1111/jgs.15944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.,RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Sara Gámez
- Badalona Serveis Assistencials, Badalona, Spain
| | - Marco Inzitari
- RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Parc Sanitari Pere Virgili, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aida Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, CIBERESP, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Miquel Gallofré
- Stroke Program, Ministry of Health of Catalonia, Barcelona, Spain
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28
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Mas MÀ, Miralles R, Renom-Guiteras A, Durán X, Inzitari M. [Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors]. Rev Esp Geriatr Gerontol 2019; 54:136-142. [PMID: 30792139 DOI: 10.1016/j.regg.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. METHODS We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. RESULTS A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. CONCLUSIONS Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.
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Affiliation(s)
- Miquel Àngel Mas
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Badalona, Barcelona, España; RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, España.
| | - Ramón Miralles
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Direcció Clínica Territorial de Cronicitat, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - Anna Renom-Guiteras
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Geriatría, Parc de Salut Mar, Barcelona, España
| | - Xavier Durán
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España
| | - Marco Inzitari
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Parc Sanitari Pere Virgili, Barcelona, España
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29
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Lee IFK, Yau FN, Yim SSH, Lee DTF. Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study. Clin Interv Aging 2018; 13:1727-1737. [PMID: 30254432 PMCID: PMC6140694 DOI: 10.2147/cia.s172871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Previous studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients. Methods This study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated. Results The final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months. Conclusion HBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.
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Affiliation(s)
- Iris Fung-Kam Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region,
| | - Felix Ngok Yau
- Nethersole Outreaching Rehabilitation Mission, Alice Ho Miu Ling Nethersole Charity Foundation, Hong Kong, Special Administrative Region
| | - Sally Suk-Ha Yim
- Nethersole Outreaching Rehabilitation Mission, Alice Ho Miu Ling Nethersole Charity Foundation, Hong Kong, Special Administrative Region
| | - Diana Tze-Fan Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region,
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30
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Abstract
Frailty is increasingly recognised as a public health priority due to the associated demand for acute and longer term health and social care support, and the impact on the lives of individuals, caregivers and families. Integrated care is widely considered to be most effective when applied to an older population, but there is limited data on outcomes and costs from studies of integrated care to prevent and manage frailty. This paper describes work by the ADVANTAGE Joint Action (JA), co-funded by the European Union and 22 Member States, to develop a common European approach to the prevention and management of frailty. The authors reflect on the emerging evidence and experience of implementing integrated care for frailty, and invite readers to participate in ongoing dialogue on this topic through the ADVANTAGE JA website and IFIC Academy activities.
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