Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators.

Introduction: This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS. Methods: Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment. Results: A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS. Conclusions: Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.

Prostate cancer detection using e-nose and AI for high probability assessment.

This research aims to develop a diagnostic tool that can quickly and accurately detect prostate cancer using electronic nose technology and a neural network trained on a dataset of urine samples from patients diagnosed with both prostate cancer and benign prostatic hyperplasia, which incorporates a unique data redundancy method. By analyzing signals from these samples, we were able to significantly reduce the number of unnecessary biopsies and improve the classification method, resulting in a recall rate of 91% for detecting prostate cancer. The goal is to make this technology widely available for use in primary care centers, to allow for rapid and non-invasive diagnoses.

Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia.

Objectives: To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain). Design: Observational, retrospective analysis of population-based central healthcare registries. Setting and participants: Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022. Methods: Deaths reported during the pre-pandemic period (2015-2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable "mortality"), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020-2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths' number observed to the expected deaths' number over the same period. Results: The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015-2019) and 105,186 within the COVID-19 period (2020-2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, -182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45-2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27-1.34), 1.03 (1.00-1.07), 0.93 (0.89-0.97), 1.13 (1.10-1.17), and 1.07 (1.04-1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to -182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs. Conclusion: Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people.

Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy.

INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program.

The Chronic Care Program introduced in Catalonia in 2011 focuses on improving the identification and management of complex chronic (CCPs) and advanced chronic patients (ACPs) by implementing an individualized care model. Its first stage is their identification based on chronicity, difficult clinical management (i.e., complexity), and, in ACPs, limited life prognosis. Subsequent stages are individual evaluation and implementation of a shared personalized care plan. This retrospective study, including all CCPs and ACPs identified in Catalonia between 2013 and 2019, was aimed at describing the characteristics and healthcare service utilization among these patients. Data were obtained from an administrative database and included sociodemographic, clinical, and service utilization variables and morbidity-associated risk according to the Adjusted Morbidity Groups (GMA) stratification. During the study period, CCPs' and ACPs' prevalence increased and was higher in lower-income populations; most cases were women. CCPs and ACPs had all comorbidities at higher frequencies, higher utilization of healthcare services, and were more frequently at high risk (63% and 71%, respectively) than age-, sex-, and income level-adjusted non-CCP (23%) and non-ACP populations (30%). These results show effective identification of the program's target population and demonstrate that CCPs and ACPs have a higher burden of multimorbidity and healthcare needs.

Frailty degree and illness trajectories in older people towards the end-of-life: a prospective observational study.

OBJECTIVES: To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival. METHODS: Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014-2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test. RESULTS: Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients). CONCLUSIONS: All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.

Tibial tray cementation is not necessary for knee revision with titanium metaphyseal sleeves: a mid-term prospective study in AORI 2B defects.

PURPOSE: Metaphyseal fixation with porous titanium sleeves in revision knee surgery provides mechanical support to the implant, promotes biological fixation, and has shown satisfactory short- and mid-term results. Cement is commonly used to fix the tibial tray to the epiphyseal area. The objective of this study is to determine whether cement should be used to achieve fixation of the tibial tray with the hypothesis that metaphyseal sleeves would provide enough axial and rotational stability making cementation unnecessary. MATERIAL AND METHODS: Prospective study of 60 patients undergoing knee replacement surgery with metaphyseal sleeves in type 2B defects in femur and tibia. Patients were divided into two groups according to the use of cement on the tibial component. Analysis included the American Knee Society Score (KSS) knee and functional scales, the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF-12) health survey, and radiographic assessment with a maximum follow-up of 5 years. RESULTS: No statistically significant differences were found between the two groups in any of the parameters assessed. CONCLUSION: Metaphyseal sleeves showed a 100% survivorship at five years of followup. There were no differences in clinical and radiographic outcomes at five years of follow-up depending on whether or not cement was used for tibial platform fixation. Cementation of the tibial tray would therefore not be required to achieve satisfactory mid-term results. LEVEL OF EVIDENCE: Level II: prospective cohort study. Therapeutic.

Risk Factors for Mortality in Nursing Home Residents: An Observational Study.

Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.

[Unusual evolution of reactive arthritis after endovesical immunotherapy with BCG].

Intravesical instillation of BCG (Bacille Calmette-Guerin) is a therapy prepared with weakened strains of Mycobacterium bovis and is an effective complementary treatment for high-risk (non-musculoinfiltrating or non-invasive) bladder cancer. Although its safety for clinical use is high, endovesical immunotherapy is not without complications. Arthralgia and arthritis are infrequent, but potentially severe, complications, the early diagnosis of which can allow adequate medical treatment and avoid chronification of the pathology. This case shows the therapeutic management of hip osteoarthritis in a 59-year-old woman, a rare and serious complication, secondary to a rare pathology such as reactive arthritis due to BCG instillation.

What lies beneath: a retrospective, population-based cohort study investigating clinical and resource-use characteristics of institutionalized older people in Catalonia.

BACKGROUND: Planning population care in a specific health care setting requires deep knowledge of the clinical characteristics of the target care recipients, which tend to be country specific. Our area virtually lacks any descriptive, far-reaching publications about institutionalized older people (IOP). We aimed to investigate the demographic and clinical characteristics of institutionalized older people (IOP) ≥65 years old and compare them with those of the rest of the population of the same age. METHODS: Retrospective analysis (total cohort approach) of clinical and resource-use characteristics of IOP and non-IOP older than 65 years in Catalonia (North-East Spain). Variables analysed included age and sex, diagnoses, morbidity burden-using Adjusted Morbidity Groups (GMA, Grupos de Morbilidad Ajustada)-, mortality, use of resources, and medications taken. All data were obtained from the administrative database of the local healthcare system. RESULTS: This study included 93,038, 78,458, 68,545 and 67,456 IOP from 2011, 2013, 2015 and 2017, respectively. In this interval, an increase in median age (83 vs. 87 years), in women (68.64% vs. 72.11%) and in annual mortality (11.74% vs. 20.46%) was observed. Compared with non-IOP (p < 0.001 in all comparisons), IOP showed a higher annual mortality (20.46% vs. 3.13%), a larger number of chronic diseases (specially dementia: 46.47% vs. 4.58%), higher multimorbidity (15.2% vs. 4.2% with GMA of maximum complexity), and annual admissions to acute care (47.6% vs. 27.7%) and skilled nursing facilities (27.8% vs. 7.4%), mean length of hospital stay (10.0 vs. 7.2 days) and mean of medications taken (11.7 vs. 8.0). CONCLUSIONS: There is a growing gap between the clinical and demographic characteristics of age-matched IOP and non-IOP, which overlaps with a higher mortality rate of IOP. The profile of resources utilization of IOP compared with non-IOP strongly suggests a deficiency of preventive actions and stresses the need to rethink the care model for IOP from a social and health care perspective.

Clinical effectiveness of an intermediate care inpatient model based on integrated care pathways.

AIM: The aim of this study was to compare the clinical impact of two intermediate care pathways. METHODS: A prospective, uncontrolled before-after study was carried out to compare two non-synchronic intermediate care frameworks in Spain. Participants in the control group were transferred to the intermediate care center by hospital request, whereas those in the intervention group (Badalona Integrated Care Model [BICM]) were transferred based on a territory approach considering the assessment of an intermediate care team. The clinical characteristics of study participants were assessed at admission and discharge. RESULTS: Compared with participants in the control group, those in the BICM group were significantly older (mean age 81.6 years [SD 10.3] vs 78.3 years [10.1], P < 0.001) and had a lower Barthel score (mean score 32.8 [SD 25.9] vs 39.9 [28.4]; P < 0.001), and a higher proportion of participants with total dependence (38.4% vs 32.2%; P = 0.001). The length of stay in intermediate care was similar in both groups; however, stay in acute care was significantly shorter in the BICM group than in the control group (mean 21 days [SD 19.5] vs 25 days [SD 23]; P < 0.001). No significant differences were found regarding the Barthel Index at discharge, although participants in the BICM group had significantly higher functional gain. CONCLUSIONS: The implementation of a territory-based integrated care pathway in an intermediate care center shifted the profile of admitted patients toward higher complexity. Despite this, patients managed under the integrated care model reduced their dependency and the referral rate to an acute unit during their stay in the intermediate care center. Geriatr Gerontol Int 2020; 20: 366-372.

Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock. / Comparación del abordaje abierto frente al artroscópico en el tratamiento del choque femoroacetabular.

OBJECTIVE: To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement who underwent either open surgery or an arthroscopic approach. METHODS: This retrospective study included patients who underwent femoroacetabular impingement surgical treatment between June 2009 and January 2018. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were radiographically and clinically assessed by alpha angle, degree of arthritis, Harris Hip Score, hospital stay and complications, as well as progression to total hip arthroplasty. RESULTS: 57 patients with FAI were included; 27 (45.6%) underwent open surgery and 31 (54.4%) underwent arthroscopy. Statistically significant differences were observed in hospital stay, where the patients who underwent arthroscopic surgery showed better outcomes. There were no other statistically significant differences, the results were similar in both groups. CONCLUSIONS: Arthroscopy and open surgery treatments for femoroacetabular impingement provided comparable clinical and radiographic results. However, the latter surgery provides better results in surgery time, hospital stay and postoperative recovery.

Influence of hospital adverse events and previous diagnoses on hospital care cost of patients with hip fracture.

Previous diagnoses of patients with hip fracture influence the hospitalization cost of these patients, either directly or by increasing the risk of in-hospital adverse events associated with increased costs. PURPOSE: To investigate how previous diagnoses influence the occurrence of in-hospital adverse events and how both factors impact on hospital costs. METHODS: This is a retrospective analysis of the hospital Minimum Basic Data Set. Patients aged 70 years or older admitted for hip fracture (HF) at a single University Hospital between January 2012 and December 2016. Both, previous diagnoses and adverse events, were defined according to the International Classification of Diseases (ICD-9/ICD-10). The anticipated cost of each admission was calculated based on diagnosis-related groups and using the "all patients refined" method (APR-DRG). The occurrence of adverse events during hospital stay was assessed by excluding all diagnoses present on admission. RESULTS: The record included 1571 patients with a mean (SD) age of 84 years. The most frequent previous diagnoses were diabetes (n = 432, 27.5%) and dementia (n = 251, 16.0%), and the most frequent adverse events were delirium (n = 238, 15.1%) and anemia (n = 188, 12.0%). The mean (SD) total acute care costs per patient were €8752.1 (1864.4). The presence of heart failure, COPD, and kidney disease at admission significantly increased the hospitalization cost. In-hospital adverse events of delirium, cardiac events, anemia, urinary tract infection, and digestive events significantly increased costs. The multivariate analyses identified kidney disease as a previous diagnosis significantly contributing to explain an increase in hospitalization costs, and delirium, cardiac disease, anemia, urinary infection, respiratory event, and respiratory infection as in-hospital adverse events significantly contributing to an increase of hospitalization costs. CONCLUSIONS: Although few baseline comorbidities have a direct impact on hospitalization costs, most previous diagnoses increase the risk of in-hospital adverse events, which ultimately influence the hospitalization cost.

Determinants of health literacy in the general population: results of the Catalan health survey.

BACKGROUND: Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia's population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. METHODS: This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. RESULTS: The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32-3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42-3.15, p <  0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34-4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. CONCLUSIONS: Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.

Complejidad y prevalencia de síndromes geriátricos de los pacientes atendidos en unidades sociosanitarias en Catalunya. Estudio multicéntrico del proyecto XARESS / Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project

Fundamentos: El objetivo fue describir la complejidad y prevalencia de síndromes geriátricos (SG) en unidades sociosanitarias de Catalunya. Métodos: Se estudiaron retrospectivamente 6.471 estancias realizadas durante el año 2014 en los centros participantes del XARESS. Los datos se obtuvieron a partir de la explotación del registro Conjunto Mínimo Básico de Datos de los Recursos Sociosanitarios (CMBD-RSS). Se analizaron de forma descriptiva las prevalencias y las asociaciones entre SG y categoría RUG al ingreso, estancia media y destino al alta, estratificando por tipo de unidad (convalecencia o larga estancia). Resultados: Los participantes presentaron una mediana de 3 SG al ingreso en larga estancia y 2 SG en convalecencia. El número de SG varió con la categoría RUG, aunque en todas ellas se identificaron pacientes sin complejidad (0 SG) y con extrema complejidad (9 SG). La presencia de SG se asoció a estancias medias más largas y mayor dependencia, aunque con gran variabilidad entre SG. No se encontró relación entre los SG y el destino al alta sociosanitaria. Conclusiones: La población atendida en centros sociosanitarios presenta una elevada complejidad y una alta prevalencia de SG al ingreso. La explotación del CMBD-RSS permite caracterizar la complejidad de las personas ingresadas en los centros de convalecencia y larga estancia de la red sociosanitaria catalana

Background: Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. Methods: A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). Results: Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. Conclusions: The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units

[Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project]. / Complejidad y prevalencia de síndromes geriátricos de los pacientes atendidos en unidades sociosanitarias en Catalunya. Estudio multicéntrico del proyecto XARESS.

BACKGROUND: Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. METHODS: A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). RESULTS: Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. CONCLUSIONS: The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units.

Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions.

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.

Does the presence of pressure ulcers entail "high risk of negative outcomes" in geriatric rehabilitation? Results from a retrospective cohort study.

AIM: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. METHODS: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. RESULTS: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs.82.5), discharge long term care setting (14 vs.6.4), discharge acute care (8.4 vs.6.2) and death (8.4 vs.4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs.83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs.53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. CONCLUSIONS: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients.

Does the presence of pressure ulcers entail «high risk of negative outcomes» in geriatric rehabilitation? Results from a retrospective cohort study / ¿Son las úlceras por presión al ingreso, un factor predictor negativo de los resultados en unidades de rehabilitación geriátrica? Resultados de un estudio de cohortes retrospectivo

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)

Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)