Abstract
Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.
Highlights
Hospital-at-home (HaH) is a healthcare modality that, for a limited period of time, provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization [1,2,3,4]
The objectives of this study were: (1) to describe the contact characteristics of both HaH modalities in Catalonia during 2014; (2) to evaluate the rates of readmission, mortality, and mean length of stay for each of the modalities; and (3) to examine which factors could be related to their results
With respect to the indicators calculated for each of the HaH modalities (Table 2), while significant differences were not found for readmissions or for mean length of stay, differences (p = 0.04) in mortality before discharge were found
Summary
Hospital-at-home (HaH) is a healthcare modality that, for a limited period of time, provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization [1,2,3,4]. Unlike other home care services that are focused on less severe patients and are carried out by primary care staff, HaH is specialized (secondary) care and, is performed by different hospital specialists. Previous studies have described two basic types of HaH: hospital admission avoidance and early assisted discharge [5,6,7]. The admission avoidance model is usually employed with elderly individuals who, instead of being admitted to acute care hospitals, are treated at home [6,8,9]. The early assisted discharge HaH model is for hospitalized patients who are able to continue their treatment at home, reducing the duration of their stay [7]
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