AI Article Synopsis
- Hospital-at-home (HaH) services, like the "Gruppo di Intervento Rapido Ospedale-Territorio" (GIROT) in Florence, offer an alternative to traditional hospital care for older adults, potentially minimizing hospital admissions and complications.
- A study of 391 patients (average age 88.4 years) revealed high mortality rates over 6 months (53.8%) and hospitalizations (37.9%), with predictors for 6-month mortality including age and severe disability.
- The GIROT model demonstrates high patient satisfaction and suggests the need for tailored care plans for older patients at risk of complications.
Article Abstract
Objective: Hospital-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.
Design: Retrospective longitudinal study.
Setting And Participants: GIROT 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.
Methods: All-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated.
Results: Among 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 Implications: The 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.
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Source |
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| http://dx.doi.org/10.1016/j.jamda.2024.105295 | DOI Listing |
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