Miquel À Mas1, Sebastià J Santaeugènia2, Francisco J Tarazona-Santabalbina3, Sara Gámez4, Marco Inzitari5. 1. 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. Electronic address: drmqagmas@gmail.com. 2. Chronic Care Program, Ministry of Health, Barcelona, Catalonia. 3. Department of Geriatric Medicine, Hospital Universitario de la Ribera, Valencia, Spain; Universidad Católica de Valencia San Vicente Martir, Valencia, Spain. 4. Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia. 5. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia; Parc Sanitari Pere Virgili, Barcelona, Catalonia.
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.
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.
Authors: Xavier Nogués; Francisca Sánchez-Martinez; Xavier Castells; Adolfo Díez-Pérez; Rosa Ana Sabaté; Irene Petit; Ariadna Brasé; Juan Pablo Horcajada; Roberto Güerri-Fernández; Julio Pascual Journal: J Am Med Dir Assoc Date: 2021-01-31 Impact factor: 4.669
Authors: Duygu Sezgin; Rónán O'Caoimh; Aaron Liew; Mark R O'Donovan; Maddelena Illario; Mohamed A Salem; Siobhán Kennelly; Ana María Carriazo; Luz Lopez-Samaniego; Cristina Arnal Carda; Rafael Rodriguez-Acuña; Marco Inzitari; Teija Hammar; Anne Hendry Journal: Eur Geriatr Med Date: 2020-08-04 Impact factor: 1.710