Clinical effectiveness of an intermediate care inpatient model based on integrated care pathways.

Autor: Santaeugènia SJ; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain.; Chronic Care Program, Ministry of Health, Barcelona, Spain.; Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain., Mas MA; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain.; RE-FiT bcn Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain., Tarazona-Santabalbina FJ; Department of Geriatric Medicine, Hospital Universitario de la Ribera, Valencia, Spain.; Valencia Catholic University Saint Vincent Martyr, Valencia, Spain., García-Lázaro M; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain., Alventosa AM; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain., Gutiérrez-Benito A; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain., Monterde A; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain., Cunill J; Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain.
Jazyk: angličtina
Zdroj: Geriatrics & gerontology international [Geriatr Gerontol Int] 2020 Apr; Vol. 20 (4), pp. 366-372. Date of Electronic Publication: 2020 Feb 18.
DOI: 10.1111/ggi.13877
Abstrakt: Aim: The aim of this study was to compare the clinical impact of two intermediate care pathways.
Methods: A prospective, uncontrolled before-after study was carried out to compare two non-synchronic intermediate care frameworks in Spain. Participants in the control group were transferred to the intermediate care center by hospital request, whereas those in the intervention group (Badalona Integrated Care Model [BICM]) were transferred based on a territory approach considering the assessment of an intermediate care team. The clinical characteristics of study participants were assessed at admission and discharge.
Results: Compared with participants in the control group, those in the BICM group were significantly older (mean age 81.6 years [SD 10.3] vs 78.3 years [10.1], P < 0.001) and had a lower Barthel score (mean score 32.8 [SD 25.9] vs 39.9 [28.4]; P < 0.001), and a higher proportion of participants with total dependence (38.4% vs 32.2%; P = 0.001). The length of stay in intermediate care was similar in both groups; however, stay in acute care was significantly shorter in the BICM group than in the control group (mean 21 days [SD 19.5] vs 25 days [SD 23]; P < 0.001). No significant differences were found regarding the Barthel Index at discharge, although participants in the BICM group had significantly higher functional gain.
Conclusions: The implementation of a territory-based integrated care pathway in an intermediate care center shifted the profile of admitted patients toward higher complexity. Despite this, patients managed under the integrated care model reduced their dependency and the referral rate to an acute unit during their stay in the intermediate care center. Geriatr Gerontol Int 2020; 20: 366-372.
(© 2020 Japan Geriatrics Society.)
Databáze: MEDLINE
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