Reducing hospital admissions and transfers to long-term inpatient care: A systematic literature review

Abstract

Individuals in need of long-term care and their relatives prefer to receive and give care in their domestic environment for as long as possible. Residential long-term care is to be avoided for as long as possible. To achieve this goal, the care setting must be optimally oriented to the needs of the person in need of care. Moreover, relatives who provide care must be professionally supported. The Regional Care Competence Center (ReKo), launched on October 1, 2019, is a quasi-experimental study (two groups and pre-post design), funded by the Innovation Fund. As part of the ReKo project, people in need of care and their relatives are assisted by a case management (CM) system. An independent CM, supported by an IT network that includes the most important service providers, is to establish a comprehensive CM for people in need of care. Based on a literature review, this paper aimed to take a conceptual approach to the ReKo project by drawing on previous research and comparing the findings with the ReKo approach. The review considered CM projects that defined avoidance of hospitalization and/or delay in the transition of care recipients to long-term inpatient care as endpoints. Using PubMed and Google Scholar, the study screened 270 articles, abstracted and quality-assessed data, and included eight randomized clinical trials, two other studies, and seven reviews in the analysis. The review results and ReKo approaches are presented along the dimensions of clinical and medical benefits, community and public health benefits, economic benefits, and political and legislative benefits. CM organizations will continue to be established internationally in aging societies. The questions of improving quality of care, avoiding service costs, and the costs of establishing a CM must be raised, even if clear evidence is difficult to provide.

Utilização dos serviços públicos de saúde especializados por pessoas idosas no sul do Brasil

“…No contexto internacional, sistemas de saúde com modelos integrados de cuidado 3 estão consolidados e evidências 4,5 têm demonstrado que a continuidade da assistência previne internações hospitalares, reduz a utilização dos serviços especializados e necessidade de exames, além de impactar positivamente na qualidade de vida dos idosos, em especial nos casos de Doenças Crônicas Não Transmissíveis (DCNT). Em levantamento de investigações nacionais sobre utilização de serviços públicos de saúde nesse grupo etário, verificou-se que a maioria das pesquisas explora os pontos de atenção da rede de forma isolada, ou seja, analisa um nível de atenção específico 1,6,7 .…”

Use of specialized public health services by older people in southern Brazil

“…In the international context, health systems with integrated care models 3 are consolidated and evidence 4,5 has shown that continuity of care prevents hospital admissions, reduces the use of specialized services and the need for tests, in addition to positively impacting the quality of life of the older people, especially in cases of Chronic Noncommunicable Diseases (CNCD). In a survey of national investigations on the use of public health services in this age group, it was found that most studies explore the points of care in the network in isolation, that is, they analyze a specific level of care 1,6,7 .…”