ABSTRACT
In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation. We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit. The hypothesis to be tested was whether improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patients with complex multimorbidity. A retrospective cohort study was performed using a sample of 714 adult patients admitted to the program between January 2012 and January 2015. We found a significant decrease in the number of emergency room visits, unplanned hospitalizations, and length of stay, and an expected increase in the home care hospital-based episodes. These results support the hypothesis that case management interventions can reduce the use of unplanned hospital admissions when applied to patients with complex multimorbidity.
ABSTRACT
BACKGROUND AND OBJECTIVES: Noninvasive home mechanical ventilation (HMV) has been shown to be beneficial for certain forms of respiratory failure, improving symptoms and quality of life. Adaptation and follow-up are usually conducted within the hospital framework. Our objective was to verify whether the same results could be obtained in the patient's home by the Home Hospitalization Unit. METHODS: This was a prospective study of patients with stable restrictive ventilatory disorders, who met the criteria to receive HMV. They underwent hospital adaptation (group 1) or ambulatory adaptation (group 2) based on geographical area. The following tests were performed throughout the follow-up: Borg scale, respiratory function, arterial blood gases, nocturnal pulse oximetry, a health survey questionnaire (SF-36), and initially, the Barthel index. Adaptation and follow-up were performed identically in both groups in accordance with the adaptation and follow-up protocol of our hospital. Independent and intergroup comparisons were made for both groups. RESULTS: Forty-two patients (21 at hospital and 21 at home) were included. No initial differences were found between the two groups. Improvements were noted on the Borg scale and for nocturnal pulse oximetry within the groups, with no differences between them. No improvement in pulmonary function was observed in either group. Arterial blood gases improved in both groups, but the ambulatory group recorded significantly higher values (PO(2), P=0.033; PCO(2), P=0.020). Most domains of the SF-36 questionnaire improved in both groups, although some intergroup differences were noted. CONCLUSIONS: HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.
Subject(s)
Home Care Services, Hospital-Based , Oxygen Inhalation Therapy/methods , Pulmonary Disease, Chronic Obstructive/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Delivery of Health Care/organization & administration , Female , Follow-Up Studies , Humans , Male , Middle Aged , Oximetry/methods , Oxygen Inhalation Therapy/psychology , Prospective Studies , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life/psychology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/psychologyABSTRACT
Se presentan datos de prevalencia de disfagia en población atendida tras hospitalización aguda en seguimiento por una unidad de hospitalización a domicilio (UHD). Se investigan 440 pacientes admitidos de forma consecutiva en la UHD del Hospital la Fe, en los que se valora la presencia de disfagia previa y tras el episodio agudo y su relación con edad y comorbilidad. Se realiza intervención nutricional en domicilio y control clínico al mes. La prevalencia de disfagia durante el proceso agudo de hospitalización y permanencia en la UHD fue del 31,8% (intervalo de confianza [IC] del 95%, 27,6-36,4%), siendo ésta significativamente mayor que la previa al ingreso: 23,0% (IC del 95%, 19,5-26,5%); p 0,05). La mortalidad durante el primer mes fue del 12,0%. Las medidas de detección y tratamiento específico adoptadas no evitaron cifras elevadas de disfagia (8%) en el seguimiento. Se concluye que la disfagia es un problema frecuente en unidades que atienden a población con edad avanzada y comorbilidad de tipo neurológico, que aumenta con la hospitalización reciente y requiere una intervención específica tras el alta
We present data on the prevalence of dysphagia in a population followed-up by a hospital at home unit after acute hospitalization. A total of 440 consecutive patients were studied. The presence of dysphagia before and after the acute episode and its association with age and comorbidity were evaluated. The patients underwent a domiciliary nutritional intervention and clinical evaluation at 1 month was performed. The prevalence of dysphagia during the acute hospitalization phase and follow-up by the hospital at home unit was 31.8% (95% confidence interval [CI], 27.6-36.4%), which was significantly higher than that before admission: 23.0% (95% CI, 19.5-26.5%); p 0.05). Mortality during the first month was 12.0%. The detection methods and specific treatments adopted did not prevent dysphagia in a high percentage of patients (8%) during follow-up. In conclusion, dysphagia is a frequent problem in units attending the elderly population with neurological comorbidity. This disorder increases with recent hospitalization and requires specific interventions after discharge
