Home-based Care Research Articles

Home-based nursing care: what do we know about multidrug-resistant organisms in this setting?

Abstract Background The burden and complexity of home-based nursing care have intensified due to earlier discharges from hospitals and patients living longer at home with increasing co-morbidities. This growing population of vulnerable patients, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on home-based nursing staff. Home-based nursing care differs significantly from hospitals and nursing homes, challenging implementation of infection prevention and control (IPC) measures. It is therefore important to gain insight into the attitudes, experiences and needs of home-based nursing staff. Also, to better understand the scope of MDRO carriage and transmission in this setting, including its challenges. Methods Cross-sectional studies were conducted in the Netherlands including a survey and focusgroup study among home-based nursing staff, supplemented by a report of cases of MDRO clusters. Results We have identified several factors adding to the complexity of responding to an MDRO outbreak with involvement of home-based nursing care. First, inapplicable recommendations in guidelines/protocols or from infection preventionists, often aimed at intramural care. Second, nursing staff questioned the proportionality of IPC measures, potentially influenced by behaviour of colleagues and patients. Third, inadequate information transfers about patients carrying MDROs. Fourth, uncertainty about the roles and responsibilities of involved healthcare professionals. Finally, the need for organisational support in providing education and sufficient resources, and clarity about financial aspects. Conclusions Insights from these studies have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands, which factor in the above mentioned complexity. Furthermore, these findings can aid in future strategies to prevent or respond early in MDRO outbreaks with involvement of home-based nursing care.

Ethical Dilemmas in Home Palliative Care

Abstract Background In the past two decades, there has been a noticeable shift towards home-based care, reflecting the broader trend among OECD countries to prioritize a comprehensive approach to health and well-being. This approach emphasizes preventive and proactive measures, often relying on home-based care delivered by multidisciplinary teams providing both curative and palliative care. However, the unique nature of providing care in a home environment raises ethical questions among healthcare providers, necessitating high levels of attentiveness and sensitivity from the caregiving team to address them effectively. Research Objectives This study aims to identify ethical challenges encountered by a multidisciplinary team, as perceived by managers of an organization offering home palliative services in Israel. Methods A qualitative study was conducted, involving interviews with nine key managers to explore prevalent ethical issues in delivering home-based care. Findings Thematic analysis unveiled common ethical dilemmas in providing Home Palliative Care. These dilemmas include balancing patient preferences with professional obligations, addressing the needs of both patients and their families, navigating caregiver-patient relationships, understanding patients’ cultural backgrounds, and advocating for home care as the preferred option while considering alternative treatment approaches. Conclusions Home palliative care poses ethical dilemmas for caregiving teams. It’s imperative for organizations in the home care sector to devise strategies aimed at assisting teams in navigating these challenges while upholding the autonomy and dignity of patients within their home environment. Key messages • Home-based care faces ethical challenges, requiring strategies to balance patient preferences and professional duties. • Ethical home hospice care needs strategies that respect patient autonomy and dignity.

Home-based nursing care for clients carrying multidrug-resistant organisms: a focus group study

Abstract Background The growing population of vulnerable clients receiving home-based nursing care, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study aimed to gain insight into the experiences, attitudes, perceptions, dilemmas in daily practice and needs of nursing staff providing home-based nursing care for clients carrying MDROs. Methods Seven focus group discussions with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semi-structured, open-ended topic list based on the I-change model and seven domains synthesized by Flottorp et al. Data were analysed using thematic analysis. Results Home-based nursing staff often considered infection prevention and control recommendations inconsistent, unclear or inapplicable in daily practice. Although participants acknowledged the importance of these precaution measures, their proportionality was sometimes questioned. Participants indicated to be influenced by perceptions, knowledge and behaviour of their colleagues and clients. In addition, they frequently experienced untimely, incomplete or inconspicuous information transfers about clients carrying MDROs. Concerns were expressed that clients were often insufficiently informed, debating the roles and responsibilities of involved healthcare professionals in providing and exchanging information. Finally, participants elaborated on the effect of the covid-19 pandemic and expressed the need for organisational support in providing education and sufficient resources regarding MDROs. Conclusions Insights of this study have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands. Organisational support in expanding knowledge and providing sufficient resources is essential and clarity about roles and responsibilities of involved healthcare professionals regarding information transfer and informing patients is needed. Key messages • Expanding knowledge, sufficient resources and adequate information transfer about MDRO carriage are essential to ultimately prevent transmission and spread of MDROs. • The specific context of home-based nursing care for clients carrying MDROs should be acknowledged in MDRO guidelines.

Characteristics of adolescent and young adult patients with cancer receiving home-based palliative care: A retrospective study at a single center.

Adolescents and young adults (AYA) with cancer require highly individualized, age-specific end-of-life care. This study identified the characteristics of AYA patients with cancer receiving home-based palliative care and explored their unique needs and challenges compared with other age groups. This retrospective cohort study analyzed the medical records of AYA patients with cancer to compare home-based palliative care characteristics with those of older age groups. The study included 81 AYA patients with cancer aged 16-39years who had received home palliative care at a single institution from 2013 to 2023. They were compared with 5,017 patients with cancer aged 40years and older. Patient background, duration of home end-of-life care, sedation, and association with social factors were examined retrospectively from medical records. The median age of AYA patients with cancer was 34years; 65.4% were female. The primary cancer sites were gastrointestinal (34.6%) and thoracic (23.5%), with 80.0% at Stage IV. The median home care duration was 28.5days, shorter than that for older patients (40days) (p < 0.0001). Home care rates were similar between AYA and older patients (82.4% vs. 79.9%, p = 0.16). Sedation was more common in the 30-39 age group than in the 16-29 group (33.3% vs. 6.3%, p = 0.049). AYA patients with cancer achieved a high rate of end-of-life care at home, although their duration of home care was shorter. The characteristics of home care varied depending on the primary site and age, highlighting the importance of creating highly individualized care plans.

4.C. Scientific session: Navigating through complex challenges of responding to outbreaks of multidrug-resistant organisms

Abstract Antimicrobial resistance is one of the top ten global public health threats according to the WHO, contributing to millions of deaths each year. While outbreaks of multidrug-resistant organisms (MDROs) are well studied in hospital and nursing home settings, knowledge gaps exist concerning the complex challenges of outbreaks of MDROs among vulnerable patient populations, such as patients with intellectual disabilities or elderly patients living longer at home with multiple comorbidities. The coordination of such outbreaks requires a multidisciplinary approach as these patients often receive care throughout different healthcare settings, including long-term care and home-based nursing care. We delve into the complexities of coordinating an MDRO outbreak response involving healthcare professionals from various healthcare settings. The challenges inherent to the coordination of multidisciplinary involvement and the use of innovative strategies for outbreak preparedness and surveillance, will be thoroughly examined based on scientific evidence and practice based experiences. Workshop objectives • To exchange experiences on managing cross-institutional outbreaks of MDROs • To foster deeper understanding of the complexities of multidisciplinary involvement during MDRO outbreaks among vulnerable patient populations The workshop structure: - A brief introduction will be provided on the generic challenges in providing long-term care to vulnerable patient populations carrying MDROs. We will subsequently illustrate potential challenges faced during a cross-institutional MDRO outbreak among these patients through a realistic scenario (5 min): A patient with severe intellectual and physical disabilities living in both a long-term care facility as well as with family at home, unexpectedly turns out to be carrying an MDRO after recent hospital admission. As the patient receives nursing care from both from family members and nursing staff in different healthcare settings, a cross-institutional MDRO outbreak has occurred requiring a coordinated response. - Hereafter, individual presenters will address evidence- and experience-based challenges faced in MDRO outbreak responses within the specific healthcare settings covered in the previously presented scenario. We will navigate through the scenario together with the participants, discussing practical and ethical dilemmas, and explore ways for containing the MDRO outbreak while maintaining effective and compassionate healthcare delivery. In addition, we will discuss the use of public health innovations, such as social network analysis as a basis for the development of a stress test exercise to improve preparedness for MDRO outbreaks, and the role of wastewater surveillance in MDRO outbreaks. Discussions will be facilitated by (online) voting tools to invite participants to exchange experiences (40 min). We conclude with an exciting quiz to summarize the key messages of this workshop (10 min). Key messages • Healthcare setting, knowledge, proportionality and well-being of vulnerable patients populations are important to acknowledge during cross-institutional MDRO outbreaks. • Novel stress test exercise and wastewater surveillance are potential methods to improve preparedness and surveillance, respectively, during cross-institutional MDRO outbreak responses.

Family caregivers’ administration of medications at the end-of-life in China: a qualitative study

BackgroundEffective medication management is crucial for ensuring timely pain and symptom control at the end of life. Dying in pain is a major concern for patients, yet some find less effective pain control at home. Family caregivers (FCGs) play a vital role in managing pain and symptom control for dying patients. However, the experience of administering medications at home for terminal-stage patients has not been widely recognized or understood. Our study aimed to explore the experiences of FCGs in administering medications to adult dying patients.MethodsWe conducted a directed content analysis of data from 73 semi-structured interviews with FCGs across 19 Chinese provinces from 2021 to 2023. FCGs were recruited through the Voluntary Cooperative Network Research. We asked, “Could you recall the end-of-life care process for the patients?” We aligned the themes with the five issues identified by Wilson et al. (2018): administration, organizational skills, empowerment, relationships, and support.ResultsFCGs in China exhibit concerns about over-engagement and empowerment in medication administration, concealing medication information from the patient, and medication accessibility. FCGs faced significant challenges in accurately identifying and addressing pain and symptoms, determining appropriate dosages, accessing effective medications, and managing the emotional stress associated with potential medication errors. Financial burden, medication regulatory restrictions, geographical inequality, and travel restrictions during COVID impeded patients and FCGs from accessing medication. A culturally specific finding is the use of alternative medicine at the end of life.ConclusionOur findings build upon Wilson et al.‘s framework and extend their insights on empowerment, highlighting the need for policies to support home-based palliative care professionals in training FCGs for effective medication administration.

Smart Home Technologies for Enhancing Independence of Living and Reducing Care Dependence in Older Adults: A Systematic Review.

To systematically review the potential of smart home technology to enhance the independence of older adults and reduce their dependence on care. Additionally, it sought to examine the positive impacts of such technology on their golden years. A systematic review based on Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The search was conducted on 8 April 2024. Peer-reviewed studies in PubMed, Embase, Web of Science, IEEE Xplore, Scopus, The Cochrane Library, CINAHL, CNKI, WANFANG DATA and VIP from 1 January 2000 to 8 April 2024 were searched. The methodological quality assessment used the Mixed Methods Appraisal Tool (MMAT). Positive findings relevant to this study were extracted from the literature and analysed using thematic synthesis. After meticulously examining 3404 studies, we identified 21 relevant sources for in-depth analysis, including qualitative studies (n = 10), experimental studies (n = 9) and mixed method studies (n = 2). These sources were grouped into five core themes based on the pivotal role of smart home technologies in enabling ageing in place: daily monitoring, assisted living activities, life reminders, functional improvement and emotional companionship. The study found that smart home technology offers numerous benefits to the lives of older adults, including increased independence, psychological support, improved cognitive functioning, enhanced self-management, increased mobility, support for caregivers, promoted social engagement and enhanced quality of life. Smart home technology can enhance the independence of older adults' lives, reduce their dependence on care, alleviate the burden on caregivers and promote home-based elderly care. This systematic review contributes to understanding the capability of smart home technology to promote elderly care at home and help better utilise smart home technology to benefit older adults. Older adults and their caregivers should be encouraged to adopt this technology to improve older adults' quality of life. No patient or public contribution.

Perceptions of physicians caring for pediatric patients with cancer in Europe: insights into the use of palliative care, its timing, and barriers to early integration

BackgroundIntegrating pediatric palliative care (PPC) into pediatric oncology standard care is essential. Therefore, it is important to assess physicians’ knowledge and perceptions of PPC to optimize its practice.ObjectiveTo evaluate the knowledge, comfort levels, and perspectives of physicians regarding the timing and perceived barriers to integrating PPC into pediatric cancer care across Europe.DesignThe Assessing Doctors’ Attitudes on Palliative Treatment (ADAPT) survey, originally developed for other global regions, was culturally and contextually adapted for Europe.Setting/SubjectsThe survey was distributed via the European Society of Paediatric Oncology (SIOPE) membership listserv. Any physicians caring for children with cancer across Eastern, Southern, Central, and Northern Europe were invited to complete the survey.ResultsA total of 198 physicians from 29 European countries completed the ADAPT survey. Physicians demonstrated relative agreement with the World Health Organization’s guidance; median alignment was 83.4% (range 59.9%-94.1%). Although most respondents felt comfortable addressing physical (84.4%) and emotional (63.4%) needs, they felt less comfortable addressing spiritual needs (41.9%) and providing grief and bereavement support (48.5%). There were significant regional differences, such as physicians in Eastern and Southern Europe reporting a lack of PPC specialists, opioids, and home-based care, while those in Northern and Central Europe did not.ConclusionPhysicians caring for children with cancer throughout Europe have a good understanding of PPC. However, misconceptions about PPC persist, requiring educational and capacity-building efforts. Additionally, the regional differences in perceived barriers must be addressed to ensure equitable access to PPC for all European children with cancer.

Home-based care services for elderly dependent adults. A comparative analysis of Madrid and Stockholm

This article analyses the situation of the Home Care Service in the two European cities of Madrid and Stockholm. There are significant differences in the development of this service in these cities which can explained by their diverse welfare models. At the same time, they also show similar trends, such as an ageing population and new demands by the elderly. The text focuses on the evolution of the service in three different dimensions: governance, working conditions and the tendering/monitoring system. The analysis is based on qualitative research, showing the predominant discourses among the key actors involved in the design and provision of the service. The results reveal the urgent need to redefine this service to respond to the new demands of the elderly as well as the changing regulatory frameworks.

Feasibility of prospective error reporting in home palliative care: A mixed methods study.

Prospectively tracking errors can improve patient safety but little is known about how to successfully implement error reporting in a home-based palliative care context. Explore the feasibility of implementing an error reporting system in a home-based palliative care program in Toronto, Canada, and describe the possible factors that may influence uptake. A convergent mixed-methods approach was used. Participants prospectively documented errors using a novel reporting tool and completed monthly surveys. Following the reporting period, we conducted a semi-structured interview exploring participants' experiences and perceived factors influencing reporting behaviors. Error, survey, and interview data were analyzed separately, then integrated for comparison. Thirteen palliative care physicians from a single home-based palliative care organization in Toronto, Canada anonymously reported errors between October 2021 and September 2022. Of these, six participated in the exit interview. Participants reported 195 errors; one-third (n = 65) involved internal staff or systems. Three themes describe the factors impacting the likelihood of reporting errors: (1) High levels of cognitive burden decreases the likelihood of error reporting; (2) Framing errors as opportunities to learn rather than reason for punishment improves likelihood of error reporting; (3) Knowing that error data will improve patient safety motivates individuals to report errors. Physicians are amenable to error reporting activities so long as data is used to improve patient safety. The collaborative nature of care in a home-based palliative care context may present unique challenges to translating error reporting to improved patient safety.

Towards Transforming Neurorehabilitation: The Impact of Artificial Intelligence on Diagnosis and Treatment of Neurological Disorders.

Background and Objectives: Neurological disorders like stroke, spinal cord injury (SCI), and Parkinson's disease (PD) significantly affect global health, requiring accurate diagnosis and long-term neurorehabilitation. Artificial intelligence (AI), such as machine learning (ML), may enhance early diagnosis, personalize treatment, and optimize rehabilitation through predictive analytics, robotic systems, and brain-computer interfaces, improving outcomes for patients. This systematic review examines how AI and ML systems influence diagnosis and treatment in neurorehabilitation among neurological disorders. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, and Scopus databases with a search time range from 2014 to 2024. This review has been registered on Open OSF (n) EH9PT. Results: Recent advancements in AI and ML are revolutionizing motor rehabilitation and diagnosis for conditions like stroke, SCI, and PD, offering new opportunities for personalized care and improved outcomes. These technologies enhance clinical assessments, therapy personalization, and remote monitoring, providing more precise interventions and better long-term management. Conclusions: AI is revolutionizing neurorehabilitation, offering personalized, data-driven treatments that enhance recovery in neurological disorders. Future efforts should focus on large-scale validation, ethical considerations, and expanding access to advanced, home-based care.

Mothers’ and caregivers’ experiences of COVID-19 restrictions during postpartum hospitalisation: a cross-sectional survey in France

BackgroundTransmission of SARS-CoV-2 highlighting the importance of social distancing guidelines. Following a series of lockdowns and the widespread vaccination of the European population, many countries began to lift these restrictions. During this period, while some parents yearned for emotional support and family presence, others found that the solitude facilitated by the restrictions was beneficial for bonding and breastfeeding. In France, postnatal stays are generally longer than in other countries, and the limited availability of home-based follow-up care, combined with pandemic isolation measures, further complicated perspectives on visitation restrictions. Therefore, the objective of this study was to assess the satisfaction of mothers and caregivers regarding these visit restrictions in French maternity settings during the COVID-19 pandemic.MethodsWe conducted two multicentre descriptives surveys across five French maternity wards (three in Paris and two in Lyon) from June 1st to July 15th, 2021. Participants included mothers, selected based on criteria such as French-speaking, at-term birth (≥ 37 weeks), and hospitalisation with their newborn, as well as caregivers working in the postpartum units. Satisfaction with visitation restrictions was assessed using a four-point Likert scale, which was then dichotomised into “mostly satisfied” versus “mostly dissatisfied” for the analysis. Multivariable logistic regression models were used to identify factors associated with satisfaction.ResultsWe analysed complete responses from 430 of the 2,142 mothers (20.1%) and 221 of the 385 caregivers (57.4%) who participated during the study period. The majority of mothers (68.8%, n = 296/430) and caregivers (90.5%, n = 200/221) declare themselves satisfied with the policy of restricting visits to maternity wards. The main source of mother’s satisfaction came from a quieter stay, but they regretted the absence of their other children.ConclusionsMaternity visit restriction policies were largely supported by mothers and caregivers, especially when partners and siblings were allowed. Revisiting these policies, along with the postpartum stay length, may improve care, though further evaluation in non-pandemic settings is needed.

The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey.

Long-term care facilities (LTCFs) are communal environments for patients with chronic diseases or older adults, making them particularly susceptible to significant harm during infectious disease outbreaks. Nonetheless, LTCFs have historically been subject to less stringent infection prevention and control (IPC) mandates. This study aimed to assess the current state of LTCFs and to develop an IPC system tailored for these facilities following the coronavirus disease 2019 (COVID-19) pandemic. We conducted an online survey of 11,366 LTCFs in Korea from December 30, 2022 to January 20, 2023, to evaluate the components of IPC in LTCFs. The infectious diseases targeted for IPC included COVID-19, influenza, and scabies. Additionally, we compared institution-based and home-based long-term care insurance facilities. Overall, 3,537 (31.1%) LTCFs responded to the survey, comprising 1,819 (51.4%) institution-based and 1,718 (48.6%) home-based facilities. A majority (87.4%, 2,376/2,720) of these facilities experienced COVID-19 outbreaks. However, only 42% of home-based facilities, in contrast to 90.6% of institution-based facilities, were equipped to manage concurrent COVID-19 cases. Similarly, while 92.1% of institution-based facilities were capable of managing influenza, only 50.5% of home-based facilities could do the same. The incidence of scabies was significantly higher in institution-based facilities than in home-based ones (26.1% vs. 4.3%). Additionally, 88.7% of institution-based facilities managed scabies cases effectively, compared to only 42.1% of home-based facilities. Approximately half of the LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capabilities between institution-based facilities and home-based facilities.

Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.

Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Develop and validate criteria that identify appropriate HBPC target populations. A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age above 70) enrolled in NHATS. Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.

Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia’s health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors’ knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

Smart Homes Facilitate Age-Friendly Home Design

With the development of advanced science and technology era and the intensification of population aging, people's demand for elderly living space is increasing. In order to improve the living space environment of the elderly, this paper aims to solve a series of obstacles in the living space for the elderly, improve the convenience and security of the living space for the elderly, and create a livable environment by taking the home-based elderly care group as the research object, combining the physiological activity characteristics and psychological needs of the group, integrating the concept of barrier-free and smart home technology. Actively respond to the problem of aging, and provide solid support for the construction of a livable environment for the elderly.

Nanozyme-Based Pump-free Microfluidic Chip for Colorectal Cancer Diagnosis via Circulating Cancer Stem Cell Detection.

Circulating cancer stem cells (CCSCs) are subpopulations of cancer cells with high tumorigenicity, chemoresistance, and metastatic potential, which are also major drivers of disease progression. Herein, to achieve the prediction of tumor diagnosis and progression in colorectal cancer (CRC), a new, automated, and portable lateral displacement patterned pump-free (LP) microfluidic chip (LP-chip) with the CoPt3 nanozyme was established for CCSC capture and detection in peripheral blood and feces samples ex vivo. In this design, CoPt3@HA probes with functions of magnetic separation and colorimetric signal transduction by peroxidase-mimicking activity were applied for the capture of CCSCs and signal output in clinical samples. The generated colors of polydopamine (PDA) were quantifiable through the smartphone APP and visualizable by the naked eye in the test line (T line) and control line (C line) of the LP-chip. In the optimal experimental conditions, the CCSC concentration was sensitive to change in the range 0-105 cells mL-1, with a detection limit of 3 cells mL-1 (S/N = 3). Preliminary studies of clinical samples suggest that the platform has the potential for prediction of colorectal cancer progression and poor prognosis. Overall, the LP-chip provides potential strategies for timely diagnosis, therapeutic monitoring, and recurrence prediction to improve home-based patient care.

A New Hospital-At-Home Model for Integrated Geriatric Care: Data from a Preliminary Italian Experience

ObjectiveHospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to “Gruppo di Intervento Rapido Ospedale-Territorio” (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DesignRetrospective longitudinal study. Setting and ParticipantsGIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. MethodsAll-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. ResultsAmong 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age [odds ratio (OR), 1.039], severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. Conclusions and ImplicationsThe GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.

Exploring the patients' and family members' perspectives on home-based palliative care.

Healthcare at home is considered a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and are unable to pay for hospital care at the end of life in some countries. To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services. This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data collection was done via interviews, and simultaneously, the interviewer recorded field notes, which were all carried out within the confines of the participants' homes. Moreover, the subjects were recruited through purposive sampling, resulting in a total of six patients and six family members. The final number of participants was determined based on data saturation. The inclusion criteria encompassed individuals of all genders, aged 18 and above, and residents of Karachi, Pakistan. Those who were not able to provide information, due to any reason, were excluded from the study. The study adhered strictly to ethical considerations. The study uncovered several significant themes that provide valuable insights, including caregivers' availability, patients' inclusiveness, improved dietary pattern, psychological wellbeing, and rapid recovery in home-based care. Furthermore, the study identified themes on providing home-based palliative care, like family members' education and keeping back-ups for unforeseen situations. In contrast, the themes identified as home-based care preference over hospital care were: experienced compromised care, hospital anxiety, restricted to the available resources and higher hospital living expenses for patients and family members. The study underscored the importance of adopting a patient-centric approach. It has become evident that the comfort and familiarity of one's home environment provide a conducive backdrop for holistic healing and wellbeing.

Nurse Telephone Support for Caregivers of Older Adults at Hospital Discharge

Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL). To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital. This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach. Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone. Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge. A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge. In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.