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.
Keywords
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Article info
Footnotes
The development and analysis of this home-based program forms the core of the PhD project of Dr M.À. Mas (supervised by Drs M. Inzitari and R. Miralles) at the Universitat Autònoma de Barcelona.
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
