Hospitalización Domiciliaria Integral para la atención a pacientes mayores con procesos agudos discapacitantes: factores predictivos de éxito terapéutico |
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Authors: | Miquel Àngel Mas Ramón Miralles Anna Renom-Guiteras Xavier Durán Marco Inzitari |
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Institution: | 1. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España;2. Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Badalona, Barcelona, España;3. RE-FIT BCN Research Group, Vall d’Hebron Institute of Research (VHIR), Barcelona, España;4. Direcció Clínica Territorial de Cronicitat, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, España;5. Servicio de Geriatría, Parc de Salut Mar, Barcelona, España;6. Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España;7. Parc Sanitari Pere Virgili, Barcelona, España |
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Abstract: | IntroductionSeveral authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates.MethodsWe performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥ 35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes.ResultsA total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with OR (95% CI)]: orthopaedic as main diagnosis 2.00 (1.22-3.29)], Barthel score at admission higher than 40 points 2.00 (1.18-3.38)], and the absence of pressure ulcers at admission 2.80 (1.68-4.65)].ConclusionsPatients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results. |
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Keywords: | Autor para correspondencia Hospitalización domiciliaria Factores pronósticos Procesos agudos discapacitantes Atención integrada Rehabilitación comunitaria Hospital-at-home Prognostic factors Disabling acute processes Integrated care Community rehabilitation |
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