Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers

Abstract

A retrospective study on 1,436residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. Residents were 88years old with 69% of women with functional disability and the care was mainly represented by the complex dressing (68%). For the care pathway, 65% of the referrers were from the NH and 35% from the hospital settings, 33% of the residents died at the end of the stay in the NH and 25% were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p <0.001), younger (p <0.001), receiving more often intravenous treatment and palliative care (p <0.01) with a higher level of indice of Karnofsky (p <0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p <0.001). Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.