Abstract
BackgroundPreventive home visits are suited for patients with reduced mobility, such as older people. Healthcare needs for older patients are expected to increase due to the extended life expectancy estimated in coming years. The implementation of low-cost, patient-centered methodologies may buffer this rise in health care costs without affecting the quality of service. In order to find the best home care model with less investment, this paper describes a study protocol comparing two models of home care for older people.MethodsWe describe a quasi-experimental study that compares the outcome of two different home care models already implemented in two primary care centers in Badalona (Barcelona, Spain). The traditional model (control model) is integrated in the sense that is continuous, the same primary care center team looks after its assigned patients both at the center and in preventive home visits. The new functional home care model (study model), consisting of a highly trained team, is specifically designed to meet patient needs and give total attention to preventive home interventions. The study will start and end on the expected dates, June 2018 to October 2020, and include all patients over 65 years old already enrolled in the home care programs of the primary care centers selected. The primary endpoint assessed will be the difference in hospitalization days between patients included in both home care programs. Other variables regarding health status, quality of care and resource utilization will also be compared between the two models.DiscussionThe study in progress will assess whether a functional and highly trained home care team will meet the ever-aging population needs in terms of cost and health outcomes better than a traditional, integrated one. Lessons learned from this pilot study will provide guidelines for a future model of home care based on the IHI Triple Aim: better care, better health, and lower costs.Trial registrationRegistered in ClinicalTrials.gov (Identifier: NCT03461315; March 12, 2018).
Highlights
Preventive home visits are suited for patients with reduced mobility, such as older people
This study aims to compare two home care (HC) programs for older people applied in Catalonia: a traditional integrated HC model provided by healthcare professionals of primary care units and a specific full-time unit of medical professionals based on a functional HC model
Since life expectancy of the population is increasing in developed countries, healthcare policymakers are prompted to tailor healthcare services to the specific needs of older people
Summary
Preventive home visits are suited for patients with reduced mobility, such as older people. Other extensively applied models are based on skilled HC teams dedicated solely to athome interventions; this approach, known as functional HC, increases specialization of the HC team and reduces the overburden of health care professionals, but may hamper the cohesion of healthcare services [14,15,16] These models were implemented with positive outcomes regarding patients’ quality of life and care delivery satisfaction. Even healthcare environments were HC is well established as a reality for care of older and disabled people acknowledge that more in-depth analysis is needed to improve understanding of the role of HC in the future of health care delivery [18] Taken together, this heterogeneity precludes the appraisal of the benefits and drawbacks of HC approach, often leading to inconclusive evidence [19]
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