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Open Access 01-12-2024 | Research

Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance

Authors: Rubèn González-Colom, Gerard Carot-Sans, Emili Vela, Mireia Espallargues, Carme Hernández, Francesc Xavier Jiménez, David Nicolás, Montserrat Suárez, Elvira Torné, Eulalia Villegas-Bruguera, Fernando Ozores, Isaac Cano, Jordi Piera-Jiménez, Josep Roca

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

Hospital at home (HaH) was increasingly implemented in Catalonia (7.7 M citizens, Spain) achieving regional adoption within the 2011-2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015-2019) in a consolidated regional program and provide context-independent recommendations for continuous quality improvement of the service.

Methods

A mixed-methods approach was adopted, combining population-based retrospective analyses of registry information with qualitative research. HaH (admission avoidance modality) was compared with a conventional hospitalization group using propensity score matching techniques. We evaluated the 12-month period before the admission, the hospitalization, and use of healthcare resources at 30 days after discharge. A panel of experts discussed the results and provided recommendations for monitoring HaH services.

Results

The adoption of HaH steadily increased from 5,185 episodes/year in 2015 to 8,086 episodes/year in 2019 (total episodes 31,901; mean age 73 (SD 17) years; 79% high-risk patients. Mortality rates were similar between HaH and conventional hospitalization within the episode [76 (0.31%) vs. 112 (0.45%)] and at 30-days after discharge [973(3.94%) vs. 1112(3.24%)]. Likewise, the rates of hospital re-admissions at 30 days after discharge were also similar between groups: 2,00 (8.08%) vs. 1,63 (6.58%)] or ER visits [4,11 (16.62%) vs. 3,97 (16.03%). The 27 hospitals assessed showed high variability in patients’ age, multimorbidity, severity of episodes, recurrences, and length of stay of HaH episodes. Recommendations aiming at enhancing service delivery were produced.

Conclusions

Besides confirming safety and value generation of HaH for selected patients, we found that this service is delivered in a case-mix of different scenarios, encouraging hospital-profiled monitoring of the service.

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Title: Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance
Authors: Rubèn González-Colom
Gerard Carot-Sans
Emili Vela
Mireia Espallargues
Carme Hernández
Francesc Xavier Jiménez
David Nicolás
Montserrat Suárez
Elvira Torné
Eulalia Villegas-Bruguera
Fernando Ozores
Isaac Cano
Jordi Piera-Jiménez
Josep Roca
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-024-10603-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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