1
|
Ugarte A, Bachero I, Cucchiari D, Sala M, Pereta I, Castells E, Subirana N, Loscos A, García L, Cardozo C, Rico V, García-Poutón N, Torres M, Lopera C, Aldea A, Suárez A, Coloma E, Seijas N, Altés J, Nicolás D. Effectiveness and Safety of Postoperative Hospital at Home for Surgical Patients: A Cohort Study. Ann Surg 2024; 279:727-733. [PMID: 38116685 DOI: 10.1097/sla.0000000000006180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To determine the feasibility and effectiveness of a Hospital at Home (HaH) enabled early transfer pathways for surgical patients. BACKGROUND HaH serves as a safe alternative to traditional hospitalization by providing acute care to patients in their homes through a comprehensive range of hospital-level interventions. To our knowledge, no studies have been published to date reporting a large cohort of early home-transferred patients after surgery through a HaH unit. METHODS Cohort study enrolling every patient admitted to the HaH unit of a tertiary hospital who underwent any of 6 surgeries with a predefined early transfer pathway and fitting both general and surgery inclusion criteria (clinical and hemodynamic stability, uncomplicated surgery, presence of a caregiver, among others) from November 2021 to May 2023. Protocols were developed for each pathway between surgical services and HaH to deliver the usual postoperative care in the home setting. Discharge was decided according to protocol. An urgent escalation pathway was also established. RESULTS During the study period, 325 patients were included: 141 were bariatric surgeries, 85 kidney transplants, 45 thoracic surgeries, 37 cystectomies, 10 appendicectomies, and 7 ventral hernia repairs. The overall escalation of care during HaH occurred in 7.3% of patients and 30-day readmissions in 7%. Most adverse events were managed at home and the overall mortality was zero. The total mean length of stay was 8 days (interquartile range 2-14), and patients with HaH were transferred home 3 days (interquartile range 1-6) earlier than the usual pathway; a total of 1551 bed-days were saved. CONCLUSIONS The implementation of early home transfer pathways for surgical patients through HaH is feasible and effective, with favorable safety outcomes.
Collapse
Affiliation(s)
- Ainoa Ugarte
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Irene Bachero
- General Surgery and Digestive System Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - David Cucchiari
- Nephrology and Urology Service, Kidney Transplant Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Sala
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Irene Pereta
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nuria Subirana
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andrea Loscos
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Laura García
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Infectious Diseases Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Verónica Rico
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Infectious Diseases Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nicol García-Poutón
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Infectious Diseases Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Manuel Torres
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Infectious Diseases Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anna Aldea
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adolfo Suárez
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Altés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic of Barcelona, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Hernandez C, Herranz C, Baltaxe E, Seijas N, González-Colom R, Asenjo M, Coloma E, Fernandez J, Vela E, Carot-Sans G, Cano I, Roca J, Nicolas D. The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service. Cost Eff Resour Alloc 2024; 22:30. [PMID: 38622593 PMCID: PMC11017527 DOI: 10.1186/s12962-024-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). METHODS A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017-2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. RESULTS HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs. 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). CONCLUSIONS The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. REGISTRATION ClinicalTrials.gov (26/04/2017; NCT03130283).
Collapse
Affiliation(s)
- Carme Hernandez
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Carme Herranz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Consorci d'Atenció Primària de Salut de l'Eixample (CAPSBE), Barcelona, Spain
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Nuria Seijas
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
| | - Rubèn González-Colom
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Maria Asenjo
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Fernandez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Emili Vela
- Àrea de Sistemes d'Informació. Servei Català de la Salut, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Catalan Health Service, Barcelona, Spain
| | - Gerard Carot-Sans
- Àrea de Sistemes d'Informació. Servei Català de la Salut, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Catalan Health Service, Barcelona, Spain
| | - Isaac Cano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Roca
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Nicolas
- Hospital at Home Unit, Hospital Clínic de Barcelona. Villarroel, 170, 08036, Barcelona, Spain
- Institut Clínic de Medicina i Dermatologia (ICMID), Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Olivella A, Almenar-Bonet L, Moliner P, Coloma E, Martínez-Rubio A, Paz Bermejo M, Boixeda R, Cediel G, Méndez Fernández AB, Facila Rubio L. Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode. ESC Heart Fail 2024; 11:628-636. [PMID: 38158630 DOI: 10.1002/ehf2.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024] Open
Abstract
Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.
Collapse
Affiliation(s)
- Aleix Olivella
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar-Bonet
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pedro Moliner
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Community Heart Failure Program (UMICO), Department of Cardiology, Bellvitge University Hospital, Barcelona, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emmanuel Coloma
- Heart Failure and Transplantation Unit, Internal Medicine Department and Hospital at Home Unit, Hospital Clinic, Barcelona, Spain
- Instituto de Investigaciones Médicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antoni Martínez-Rubio
- Department of Cardiology, Hospital Universitario de Sabadell, Sabadell, Spain
- Universidad Autonoma de Barcelona, Sabadell, Spain
| | | | - Ramon Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - German Cediel
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ana Belén Méndez Fernández
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Facila Rubio
- Department of Cardiology, Hospital General de Valencia, Universitat de Valencia, Avda. Tres Cruces 2, 46014, Valencia, Spain
| |
Collapse
|
4
|
Gabara C, Montoya-Rodes M, López N, Zamora-Martínez C, Ortiz M, Morancho A, Moisés J, Osorio J, Coloma E, Font C, Jiménez S, Zarco F, Burrel M, Bermúdez P, Barrufet M, Aibar J. Inferior Vena Cava Filters: Adherence to Clinical Practice Guidelines Recommendations, Retrieval Rates, and Filter Complications in a Tertiary Hospital. Angiology 2023:33197231190184. [PMID: 37470426 DOI: 10.1177/00033197231190184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The present study evaluated the adherence to guideline recommendations regarding the indication for inferior vena cava filter (IVCF) placement, retrieval rates, complications, thrombotic recurrences, and mortality. Patients in whom an IVCF was placed between 2015 and 2020 in a tertiary hospital were retrospectively included. We considered absolute indication of IVCF placement if all the guidelines evaluated agreed on the indication, relative indication if only some guidelines recommended it and without indication if none of the evaluated guidelines recommended it. From the 185 patients included; 47% had an absolute indication, 15% a relative indication, and 38% had no indication. Filter-associated complications and non-removal rates were 12.4% and 41%, respectively. Venous thromboembolism recurrence rate was 17.8%, being filter-associated complications (24.2 vs 9.8%, P = .02) and thrombosis of the inferior cava or iliac veins (12.1 vs 2.6%, P = .03) more frequent in this group. The mortality rate was 40%, with higher mortality risk in patients with co-existing cancer. Previous major bleeding, filter-associated complications, and mortality were associated with a major risk of non-removal. In conclusion, the adherence to guidelines regarding the indication of IVCF placement is still low and IVCF complications are not negligible. This fact is of special concern in the elderly, comorbid, and cancer patients.
Collapse
Affiliation(s)
- Cristina Gabara
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Néstor López
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martínez
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Alma Morancho
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jorge Moisés
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jeisson Osorio
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carme Font
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Sonia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Federico Zarco
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Burrel
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Patricia Bermúdez
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Barrufet
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Sánchez Marcos C, Espinosa B, Coloma E, San Inocencio D, Pilarcikova S, Guzmán Martínez S, Ramón M, Carratalá Ballesta A, Saavedra O, Ivars Obermeier N, Bragulat E, Gil-Rodrigo A, Ugarte A, Llorens P, Miró Ò. Safety and efficiency of discharge to home hospitalization directly after emergency department care of patients with acute heart failure. Emergencias 2023; 35:176-184. [PMID: 37350600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To analyze whether discharge to home hospitalization (HHosp) directly from emergency departments (EDs) after care for acute heart failure (AHF) is efficient and if there are short-term differences in outcomes between patients in HHosp vs those admitted to a conventional hospital ward (CHosp). MATERIAL AND METHODS Secondary analysis of cases from the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). The EAHFE is a multicenter, multipurpose, analytical, noninterventionist registry of consecutive AHF patients after treatment in EDs. Cases were included retrospectively and registered to facilitate prospective follow-up. Included were all patients diagnosed with AHF and discharged to HHosp from 2 EDs between March 2016 and February 2019 (3 years). Cases from 6 months were analyzed in 3 periods: March-April 2016 (corresponding to EAHFE-5), January-February 2018 (EAHFE-6), and January-February 2019 (EAHFE-7). The findings were adjusted for characteristics at baseline and during the AHF decompensation episode. RESULTS A total of 370 patients were discharged to HHosp and 646 to CHosp. Patients in the HHosp group were older and had more comorbidities and worse baseline functional status. However, the decompensation episode was less severe, triggered more often by anemia and less often by a hypertensive crisis or acute coronary syndrome. The HHosp patients were in care longer (median [interquartile range], 9 [7-14] days vs 7 [5-11] days for CHosp patients, P .001), but there were no differences in mortality during hospital care (7.0% vs. 8.0%, P = .56), 30-day adverse events after discharge from the ED (30.9% vs. 32.9%, P = .31), or 1-year mortality (41.6% vs. 41.4%, P = .84). Risks associated with HHosp care did not differ from those of CHosp. The odds ratios (ORs) for HHosp care were as follows for mortality while in care, OR 0.90 (95% CI, 0.41-1.97); adverse events within 30 days of ED discharge, OR 0.88 (95% CI, 0.62-1.26); and 1-year mortality, OR 1.03 (95% CI, 0.76-1.39). Direct costs of HHosp and CHosp averaged €1309 and €5433, respectively. CONCLUSION After ED treatment of AHF, discharge to HHosp requires longer care than CHosp, but short- and longterm outcomes are the same and at a lower cost.
Collapse
Affiliation(s)
| | - Begoña Espinosa
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Emmanuel Coloma
- Unidad de Hospitalización a Domicilio, Dirección Médica, Hospital Clínic, Barcelona, España
| | - David San Inocencio
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sonja Pilarcikova
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Sergio Guzmán Martínez
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Mariona Ramón
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Alejandro Carratalá Ballesta
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Omar Saavedra
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Nicole Ivars Obermeier
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Ernest Bragulat
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Ainoa Ugarte
- Unidad de Hospitalización a Domicilio, Dirección Médica, Hospital Clínic, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| |
Collapse
|
6
|
Pereta I, Morancho A, López N, Ibáñez B, Salas C, Moreno L, Castells E, Barta A, Cubedo M, Coloma E, Cardozo C, García-Pouton N, Ugarte A, Rivero A, Bodro M, Rico V, García L, Altés J, Seijas N, Nicolás D. Hospital at home treatment with remdesivir for patients with COVID-19: real-life experience. Int J Infect Dis 2023; 127:124-128. [PMID: 36521589 PMCID: PMC9744477 DOI: 10.1016/j.ijid.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Access and appropriateness of therapeutics for COVID-19 vary because of access or regulatory barriers, the severity of the disease, and for some therapies, the stage of the pandemic and circulating variants. Remdesivir has shown benefits in clinical recovery and is the treatment of choice for selected patients, both hospitalized and nonhospitalized, in main international guidelines. The use of remdesivir in alternatives to conventional hospitalization such as hospital at home (HaH) units remains incompletely explored. In this study, we aim to describe the real-life experience of outpatient remdesivir infusion for COVID-19 in a HaH unit. METHODS We selected all the consecutive patients receiving remdesivir from a prospective cohort of 507 COVID-19 patients admitted at a HaH unit. Admission criteria included COVID-19 with a fraction of inspired oxygen requirement under 0.35 and respiratory rate under 22 rpm. Patients were daily assessed in person by a nurse and a physician. RESULTS A total of 236 patients admitted at the HaH unit received remdesivir, 172 of whom were treated at home. Only 2% presented any adverse event related to the infusion, all of them mild. HaH saved 1416 day-beds, with only 5% of the patients requiring transfer back to the hospital. CONCLUSION Remdesivir infusion in HaH units seems to be a safe and efficient alternative to conventional hospitalization for treating patients with nonsevere COVID-19.
Collapse
Affiliation(s)
- Irene Pereta
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Alma Morancho
- Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Néstor López
- Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Begoña Ibáñez
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina Salas
- Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Laura Moreno
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ariadna Barta
- Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Cubedo
- Genetics, Microbiology and Statistics Department, Statistics Section, Biology Faculty, Universitat de Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Nicole García-Pouton
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Ainoa Ugarte
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Haematology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Verónica Rico
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Infectious Diseases Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Laura García
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Altés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clínic Barcelona, Barcelona, Spain,Internal Medicine Service, Hospital Clínic Barcelona, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain,Corresponding author: Tel: +34-932272030/+34610560336
| |
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
8
|
Torrallardona-Murphy O, Pericàs JM, Rabaneda-Lombarte N, Cubedo M, Cucchiari D, Calvo J, Serralabós J, Alvés E, Agelet A, Hidalgo J, Alves E, García L, Sala M, Pereta I, Castells E, Suárez A, Carbonell A, Seijas N, Feu F, Alcaraz A, Hernández C, Coloma E, Nicolás D. Medicalized Hotel as an Alternative to Hospital Care for Management of Noncritical COVID-19. Ann Intern Med 2021; 174:1338-1340. [PMID: 34125576 PMCID: PMC8252829 DOI: 10.7326/m21-1873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Juan M Pericàs
- Hospital Clínic de Barcelona and Vall d'Hebron Institute for Research, Barcelona, Spain
| | | | | | | | - Júlia Calvo
- Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Marta Sala
- Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Faust Feu
- Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Emmanuel Coloma
- Hospital Clínic de Barcelona and University of Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital Clínic de Barcelona and University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
9
|
Nicolás D, Coloma E, Pericàs JM. Alternatives to conventional hospitalisation that enhance health systems' capacity to treat COVID-19. Lancet Infect Dis 2021; 21:591-593. [PMID: 33711274 PMCID: PMC8063075 DOI: 10.1016/s1473-3099(21)00093-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/25/2023]
Affiliation(s)
- David Nicolás
- Hospital at Home Unit, Internal Medicine Service, Hospital Clínic Barcelona, University of Barcelona, Barcelona 08036, Spain.
| | - Emmanuel Coloma
- Hospital at Home Unit, Internal Medicine Service, Hospital Clínic Barcelona, University of Barcelona, Barcelona 08036, Spain
| | - Juan M Pericàs
- Infectious Disease Service, Hospital Clínic Barcelona, University of Barcelona, Barcelona 08036, Spain; Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Barcelona, Spain
| |
Collapse
|
10
|
Nicolás D, Camós-Carreras A, Spencer F, Arenas A, Butori E, Maymó P, Anmella G, Torrallardona-Murphy O, Alves E, García L, Pereta I, Castells E, Seijas N, Ibáñez B, Grané C, Bodro M, Cardozo C, Barroso S, Olive V, Tortajada M, Hernández C, Cucchiari D, Coloma E, Pericàs JM. A Prospective Cohort of SARS-CoV-2-Infected Health Care Workers: Clinical Characteristics, Outcomes, and Follow-up Strategy. Open Forum Infect Dis 2021; 8:ofaa592. [PMID: 33537362 PMCID: PMC7798565 DOI: 10.1093/ofid/ofaa592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) outbreaks, health care workers (HCWs) are at a high risk of infection. Strategies to reduce in-hospital transmission between HCWs and to safely manage infected HCWs are lacking. Our aim was to describe an active strategy for the management of COVID-19 in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected HCWs and investigate its outcomes. METHODS A prospective cohort study of SARS-CoV-2-infected health care workers in a tertiary teaching hospital in Barcelona, Spain, was performed. An active strategy of weekly polymerase chain reaction screening of HCWs for SARS-CoV-2 was established by the Occupational Health department. Every positive HCW was admitted to the Hospital at Home Unit with daily assessment online and in-person discretionary visits. Clinical and epidemiological data were recorded. RESULTS Of the 590 HCWs included in the cohort, 134 (22%) were asymptomatic at diagnosis, and 15% (89 patients) remained asymptomatic during follow-up. A third of positive cases were detected during routine screening. The most frequent symptoms were cough (68%), hyposmia/anosmia (49%), and fever (41%). Ten percent of the patients required specific treatment at home, while only 4% of the patients developed pneumonia. Seventeen patients required a visit to the outpatient clinic for further evaluation, and 6 of these (1%) required hospital admission. None of the HCWs included in this cohort required intensive care unit admission or died. CONCLUSIONS Active screening for SARS-CoV-2 among HCWs for early diagnosis and stopping in-hospital transmission chains proved efficacious in our institution, particularly due to the high percentage of asymptomatic HCWs. Follow-up of HCWs in Hospital at Home units is safe and effective, with low rates of severe infection and readmission.
Collapse
Affiliation(s)
- David Nicolás
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | - Felipe Spencer
- Ophthalmology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Andrea Arenas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eugenia Butori
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Pol Maymó
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Gerard Anmella
- Psychiatry Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Orla Torrallardona-Murphy
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eduarda Alves
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Laura García
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Irene Pereta
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Begoña Ibáñez
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Grané
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Infectious Disease Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Infectious Disease Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Sonia Barroso
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Victoria Olive
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marta Tortajada
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Cucchiari
- Renal Transplant Unit, Nephrology Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Juan M Pericàs
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Vall d’Hebron Institute for Research (VHIR), Barcelona, Spain
| |
Collapse
|
11
|
Cucchiari D, Guillén E, Cofan F, Torregrosa JV, Esforzado N, Revuelta I, Ventura-Aguiar P, Oppenheimer F, Bayés B, Marcos MÁ, Morgado-Carrasco D, López JM, Creus P, Hernández C, Coloma E, Bodro M, Diekmann F, Pericàs JM, Nicolás D. Taking care of kidney transplant recipients during the COVID-19 pandemic: Experience from a medicalized hotel. Clin Transplant 2020; 35:e14132. [PMID: 33103277 PMCID: PMC7645977 DOI: 10.1111/ctr.14132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 10/31/2022]
Affiliation(s)
- David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Guillén
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Frederic Cofan
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | | | - Nuria Esforzado
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Beatriu Bayés
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Maria Ángeles Marcos
- Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Juan Manuel López
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain
| | - Paula Creus
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain.,Department of Infectious Disease, Hospital Clínic, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Juan M Pericàs
- Department of Infectious Disease, Hospital Clínic, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
| | | |
Collapse
|
12
|
Affiliation(s)
- Emmanuel Coloma
- Hospital at Home Unit, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain.,Internal Medicine Service, Hospital Clinic, Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain.,Internal Medicine Service, Hospital Clinic, Barcelona, Spain
| |
Collapse
|
13
|
Pericàs JM, Cucchiari D, Torrallardona-Murphy O, Calvo J, Serralabós J, Alvés E, Agelet A, Hidalgo J, Alves E, Castells E, Seijas N, Hernández C, Bodro M, Cardozo C, Coloma E, Nicolás D. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. Infection 2020; 49:327-332. [PMID: 32995970 PMCID: PMC7523688 DOI: 10.1007/s15010-020-01527-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Alternatives to conventional hospitalization are needed to increase health systems resilience in the face of COVID-19 pandemic. Herein, we describe the characteristics and outcomes of 63 patients admitted to a single HaH during the peak of COVID-19 in Barcelona. Our results suggest that HaH seems to be a safe and efficacious alternative to conventional hospitalization for accurately selected patients with COVID-19.
Collapse
Affiliation(s)
- Juan M Pericàs
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain. .,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain. .,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain. .,Vall D'Hebron Institute for Research (VHIR), Barcelona, Spain.
| | - David Cucchiari
- Renal Transplantation Service, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Júlia Calvo
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain
| | - Júlia Serralabós
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisenda Alvés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Aleix Agelet
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Judit Hidalgo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eduarda Alves
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - David Nicolás
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | |
Collapse
|
14
|
Giacomelli R, Afeltra A, Alunno A, Bartoloni-Bocci E, Berardicurti O, Bombardieri M, Bortoluzzi A, Caporali R, Caso F, Cervera R, Chimenti MS, Cipriani P, Coloma E, Conti F, D'Angelo S, De Vita S, Di Bartolomeo S, Distler O, Doria A, Feist E, Fisher BA, Gerosa M, Gilio M, Guggino G, Liakouli V, Margiotta DPE, Meroni P, Moroncini G, Perosa F, Prete M, Priori R, Rebuffi C, Ruscitti P, Scarpa R, Shoenfeld Y, Todoerti M, Ursini F, Valesini G, Vettori S, Vitali C, Tzioufas AG. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18:93-106. [PMID: 30408582 DOI: 10.1016/j.autrev.2018.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/11/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
Collapse
Affiliation(s)
- Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy.
| | - Antonella Afeltra
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandra Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Roberto Caporali
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Emmanuel Coloma
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Salvatore Di Bartolomeo
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology of the Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK; Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Maria Gerosa
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Michele Gilio
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Rheumatology section, University of Palermo, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Domenico Paolo Emanuele Margiotta
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pierluigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Rebuffi
- Grant Office and Scientific Documentation Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Yehuda Shoenfeld
- Zabludowitz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Monica Todoerti
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Athanasios G Tzioufas
- Pathophysiology Department, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
15
|
Alijotas-Reig J, Ferrer-Oliveras R, Esteve-Valverde E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, Coloma E, de Carolis S, Rovere-Querini P, Canti V, Picardo E, Fredi M, Mekinian A. Inherited thrombophilia in women with poor aPL-related obstetric history: prevalence and outcomes. Survey of 208 cases from the European Registry on Obstetric Antiphospholipid Syndrome cohort. Am J Reprod Immunol 2016; 76:164-71. [DOI: 10.1111/aji.12534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit; Department of Internal Medicine; Vall d'Hebron University Hospital; Barcelona Spain
- Department of Medicine; Universitat Autonoma; Barcelona Spain
| | - Raquel Ferrer-Oliveras
- Obstetric and Gynaecolgy Department; Vall d'Hebron University Hospital; Universitat Autonoma; Barcelona Spain
| | - Enrique Esteve-Valverde
- Systemic Autoimmune Disease Unit; Department of Internal Medicine; Vall d'Hebron University Hospital; Barcelona Spain
- Internal Medicine Department; Althaia Healthcare Network of Manresa; Barcelona Spain
| | - Amelia Ruffatti
- Rheumatology Unit; Department of Clinical and Experimental Medicine Azienda Ospedaliera; University of Padua; Padua Italy
| | - Angela Tincani
- Rheumatology and Clinial Immunology Unit; Ospedale Civile; Brescia Italy
| | - Elmina Lefkou
- Haematology Unit; Hippokration Hospital of Thessaloniki; Thessaloniki Greece
| | | | - Gerard Espinosa
- Systemic Autoimmune Diseases Service; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Emmanuel Coloma
- Systemic Autoimmune Diseases Service; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Sara de Carolis
- Depatment of Gynaecology; Gemmeli Hospital; Catholic University; Roma Italy
| | - Patrizia Rovere-Querini
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele; Milano Italy
| | - Valentina Canti
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele; Milano Italy
- Laboratorio Autoimmunità e Inflammazione Voscolare - San Raffaele DIBIT; Milano Italy
| | - Elisa Picardo
- Department of Obstetrics and Gynaecology; University of Turin; Turin Italy
| | - Micaela Fredi
- Rheumatology and Clinial Immunology Unit; Ospedale Civile; Brescia Italy
| | - Arsene Mekinian
- Department of Medicine; Hôpital Saint-Antoine; Universite Est Parisien; Paris France
| | | |
Collapse
|
16
|
Bosch X, Coloma E, Donate C, Colomo L, Doti P, Jordán A, López-Soto A. Evaluation of unexplained peripheral lymphadenopathy and suspected malignancy using a distinct quick diagnostic delivery model: prospective study of 372 patients. Medicine (Baltimore) 2014; 93:e95. [PMID: 25310744 PMCID: PMC4616296 DOI: 10.1097/md.0000000000000095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although rapid diagnostic testing is essential in suspicious peripheral lymphadenopathy, delays in accessing them can be considerable. We investigated the usefulness of an internist-led outpatient quick diagnosis unit (QDU) in assessing patients with unexplained peripheral lymphadenopathy, focusing on the characteristics, diagnostic, and treatment waiting times of those with malignancy. Patients aged ≥ 18 years, consecutively referred from 12 primary health care centers (PHCs) or the emergency department (ED) for unexplained peripheral lymphadenopathy, were prospectively evaluated during 7 years. Diagnostic investigations were done using a predefined study protocol. Three experienced cytopathologists performed a fine-needle aspiration cytology (FNAC) systematic approach of clinically suspicious lymphadenopathy with cytomorphology and immunophenotyping analyses. We evaluated 372 patients with a mean age (SD) of 45.3 (13.8) years; 56% were women. Malignancy was diagnosed in 120 (32%) patients, including 81 lymphomas and 39 metastatic tumors. Metastatic lymphadenopathy was diagnosed by FNAC in all 39 patients and the primary tumor site was identified in 82% of them when cytomorphology and immunocytochemistry were combined. A correct diagnosis of lymphoma was reached by FNAC in 73% of patients. When accepting "suspicious of" as correct diagnosis, the FNAC diagnosis rate of lymphoma increased to 94%. Among patients with malignancy, FNAC yielded 1.3% of false negatives and no false positives. All patients with an FNAC report of correct or suspicious lymphoma underwent a surgical biopsy, as it is a mandatory requirement of the hematology department. Mean times from first QDU visit to FNAC diagnosis of malignancy were 5.4 days in metastatic lymphadenopathy and 7.5 days in lymphoma. Mean times from receiving the initial referral report to first treatment were 29.2 days in metastatic lymphadenopathy and 40 days in lymphoma. In conclusion, a distinct internal medicine QDU allows an expeditious, agile, and prearranged system to diagnose malignant peripheral lymphadenopathy. Because of the close collaboration with the cytopathology unit and the FNAC methodical approach, diagnostic and treatment waiting times of patients with malignancy fulfilled national and international time frame standards. This particular diagnostic delivery unit could help overcome the difficulties facing PHC, ED, and other physicians when trying to provide rapid access to investigations to patients with troublesome lymphadenopathy.
Collapse
Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine (XB, EC, CD, PD, AJ, AL-S); and Department of Pathology (Cytopathology Section) (LC), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
17
|
Bosch X, Escoda O, Nicolás D, Coloma E, Fernández S, Coca A, López-Soto A. Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study. BMC Fam Pract 2014; 15:75. [PMID: 24775097 PMCID: PMC4021313 DOI: 10.1186/1471-2296-15-75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 04/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting. METHODS We carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable 'ED referral'. RESULTS We evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ=0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ=0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P=.001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49-4.55, P<.001), rectorrhagia (OR 2.18, 95% CI 1.10-3.77, P=.01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P=.002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting. CONCLUSIONS Most PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals.
Collapse
Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
| | | | | | | | | | | | | |
Collapse
|
18
|
Milisenda JC, Coloma E, Grau JM. [Beer potomania. An uncommon cause of severe hyponatremia]. Med Clin (Barc) 2012; 138:410-1. [PMID: 21940012 DOI: 10.1016/j.medcli.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 12/01/2022]
|
19
|
Coloma E, Prieto-González S, López-Giraldo A, López-Soto A. Hyperammonemic encephalopathy due to a urinary diversion: an uncommon cause of reversible dementia. J Am Geriatr Soc 2011; 59:930-2. [PMID: 21568962 DOI: 10.1111/j.1532-5415.2011.03377.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Prieto-González S, Escoda R, Coloma E, Grau JM. Amoxicillin-induced acute aseptic meningitis. J Clin Neurosci 2011; 18:443-4. [DOI: 10.1016/j.jocn.2010.07.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 06/15/2010] [Accepted: 07/29/2010] [Indexed: 01/10/2023]
|