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Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment
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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.
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HERNÁNDEZ, Carme, AIBAR GALLIZO, Jesús, SEIJAS, Nuria, PUIG, Imma, ALONSO, Albert, GARCÍA AYMERICH, Judith, ROCA TORRENT, Josep. Implementation of home hospitalization and early discharge as an integrated care service: A ten years pragmatic assessment. _International Journal of Integrated Care_. 2018. Vol. 18, núm. 2, pàgs. 12. [consulta: 25 de febrer de 2026]. ISSN: 1568-4156. [Disponible a: https://hdl.handle.net/2445/156460]