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Integrated Care in a geriatric Hospital at Home in Barcelona

Authors:

Marco Inzitari ,

Research group on Aging, Frailty and Transitions in Barcelona Vall d’Hebrón Institut de Recerca (VHIR), Spain Department of Medicine, Universitat Autònoma de Barcelona Parc Sanitari Pere Virgili Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Spain, ES
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Cristina Arnal,

Research group on Aging, Frailty and Transitions in Barcelona Vall d’Hebrón Institut de Recerca (VHIR), Spain Department of Medicine, Universitat Autònoma de Barcelona Parc Sanitari Pere Virgili, ES
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Pamela Burbano,

Parc Sanitari Pere Virgili, ES
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Ester Hoyos,

Parc Sanitari Pere Virgili, ES
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Sonia Perez,

Parc Sanitari Pere Virgili, ES
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Mireia Bisquert,

Parc Sanitari Pere Virgili, ES
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Alicia Gomez,

Parc Sanitari Pere Virgili, ES
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Miriam Colominas,

Parc Sanitari Pere Virgili, ES
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Ayoub Annaouas,

Parc Sanitari Pere Virgili, ES
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Anne Hendry,

University of the West of Scotland, GB
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Laura Monica Perez

Research group on Aging, Frailty and Transitions in Barcelona Vall d’Hebrón Institut de Recerca (VHIR), Spain Parc Sanitari Pere Virgili, ES
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Abstract

Introduction: If possible, most older adults prefer to receive healthcare at home. Conversely, most healthcare systems are mainly oriented to a bed-based model which is not optimal for older adults with complex needs. Hospital at home services are expanding but generally offer an acute ""diagnosis-treatment"" approach, and most lack a comprehensive and interdisciplinary approach. 

In 2017, Parc Sanitari Pere Virgili, a public provider of intermediate care in Barcelona, Spain, implemented a geriatric Hospital at Home (H@H) service as an alternative to hospitalization as part of the continuum of intermediate care. H@H is delivered by an integrated interdisciplinary team able to perform both step-down (early supported discharge) and step-up (admission avoidance) care. Based on comprehensive geriatric assessment, the multidisciplinary approach combines, diagnosis, individualized treatment plan and rehabilitation.

Aims and Methods: To describe the profile of the geriatric H@H team and casemix of older adults who received H@H for acute health crisis or exacerbations of chronic conditions and functional impairment.

To assess outcomes achieved in terms of Pre-post functional improvement (Barthel Index (BI) discharge-admission) and discharge destination.  

To compare outcomes achieved pre pandemic (before February 2020) and during the COVID-19 pandemic (from February 2020) periods. 

Results: Each H@H team for 15 virtual beds is supported by one geriatrician, two nurses, one physical and one occupational therapists, one social worker, and virtual speech therapy support (since 2021). H@H operates 24/7 (remote advice at night hours), provides IV treatments and basic diagnostic testing as well as treatment and rehabilitation. Referrals decreased February-October 2020 in the early stage of the pandemic.  H@H bed capacity increased to 45 across 3 H@H teams to manage increased activity and acuity as referrals resumed.

From December 2017 to October 2021, H@H managed 527 patients (57% women, mean age=82.4years) with moderate multimorbidity (mean Charlson Index=2); 51% lived with a partner, 32% had a caregiver or support. 51.6% were managed pre pandemic.

Primary admission diagnoses were orthopedic conditions (34.5%), decompensated heart failure (17%) and respiratory/urine infections (11%). Half of H@H patients had polypharmacy (8+ drugs), 57.2% had fallen in the previous six months and 26% had dementia. 51% were referred  from an acute hospital and 32% directly from primary care. Mean admission BI was 52.2 points, with a mean increase of 7.3 points at discharge. Discharge from H@H destinations were home (73%), intermediate-care hospital (7%), acute hospital (14%); mortality was 5.0%.

Changes in admission diagnosis during the pandemic were mainly due to post-stroke (from 2.9% to 10.0%) and COVID-19 (3.0%). During the pandemic, patients had higher rates of baseline walking impairment (57% Vs 21%; p<0,001), a reduction of functional gain (5.7% Vs 8.8%; p=0.014) and increased length of H@H episode (36 Vs 33 days; p=0.012) and mortality (7.8% Vs 2.7%; p=0.005).

Conclusions: A polyvalent (step-up+step-down) comprehensive geriatric assessment and management H@H provided an alternative to conventional hospitalization during the COVID-19 pandemic. Bed capacity was progressively tripled to meet increased demand for a safe and effective alternative to hospital care. This model and practice will be sustained post pandemic.

How to Cite: Inzitari M, Arnal C, Burbano P, Hoyos E, Perez S, Bisquert M, et al.. Integrated Care in a geriatric Hospital at Home in Barcelona. International Journal of Integrated Care. 2022;22(S3):304. DOI: http://doi.org/10.5334/ijic.ICIC22153
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Published on 04 Nov 2022.

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