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Title:	Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
Author:	Hernández, Carme; Aibar Gallizo, Jesús; Seijas, Nuria; Puig, Imma; Alonso, Albert; García Aymerich, Judith; Roca Torrent, Josep
Notes:	OBJECTIVE: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. METHODS: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients' and professionals' perspectives, technologies and costs were evaluated. RESULTS: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0-3) days and the length of home-based stay was 6 (5-7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918 per patient discharged, significantly lower than conventional hospitalization (2,879 ) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. CONCLUSIONS: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.
Subject(s):	-Malalts crònics -Atenció domiciliària -Salut pública -Chronically ill -Home care services -Public health
Rights:	cc-by (c) Hernández, Carme et al., 2018 http://creativecommons.org/licenses/by/3.0/es
Document type:	Article Article - Published version
Published by:	Universiteit Utrecht
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