Service evaluation comparing Acute Care at Home for older people service and conventional service within an acute hospital care of elderly ward

Abstract

Aims and Objectives: This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward.Background: Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness.Design: Quantitative design, using service evaluation methodology.Methods: A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018-March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30day, 3-and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study.Results: Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Fewer patients die while under Acute Care at Home care. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts. Conclusion:The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. It is likely that the Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults. | 2979 TIERNEY ET al. 2 | INTRODUC TI ON The world's population continues to grow and is estimated to reach 8.5 billion by 2020 (United Nations, 2019). The United Kingdom (UK) population is projected to grow by 5.5% to 69.6 million by 2026 (Office for National Statistics, 2019). In Northern Ireland (NI), the population is expected to rise by 4.4% to 1.92 million by 2024 and to 2 million by 2041. In the last decade, NI has witnessed a 25% rise in the number of people aged >65 years and a 33% rise in those aged >85 years of age (Northern Ireland Statistics & Research Agency, 2018). This rise in the number of older people and those living with chronic conditions has been attributed to improvements in healthcare technology

Who cares?—The unrecognised contribution of homecare nurses to care trajectories

“…Consequently, we argue that the dichotomy between direct patient care and organising work is a false one in modern homecare nursing. Today's homecare consists of increasing specialisation and the rise of chronic illness and multi-morbidity highlights the need for managing care trajectories [12,26,27]. Accordingly, the organisational work in homecare has to be considered in its own right as part of 'real nursing'.…”

“Virtual ward” community outreach support for COVID‐19‐positive hemodialysis patients may delay but not prevent subsequent admission to hospital: A single‐center retrospective case–control pilot study

“…Appropriate case selection and ambulant emergency management are associated with reduced length of stay, 30-day readmission rate, and functional decline in other settings and is increasingly the preferred option for acute care in the United Kingdom. 3,4,7 We are the first to report the outcomes for such a pathway for COVID-19-positive patients receiving HD and our findings have implications not only for the current COVID pandemic, but also for seasonal respiratory viruses such as influenza where cohorts with advanced renal impairment demonstrate excess mortality. 8 As this is a pilot, our study cohort is small, although we attempted to mitigate this by matching to multiple controls.…”

“…1,2 "Virtual ward" community management of acute illness decreases admission rates and length, lessening pressure on inpatient beds, and reduces mortality and the risk of deconditioning. 3,4 HD cohorts are particularly at risk of the latter due to comorbidities including sarcopenia, diabetes, and cardiovascular disease. 5 Specific interventions to prevent subsequent deterioration and admission in COVID-19-positive HD cohorts are lacking.…”

“…Cumulative time on HD therapy and past medical history of diabetes mellitus, lung disease, and recent (within 30 days of positive swab) immunosuppression did not significantly differ between groups; however, a history of cardiovascular disease was more common in controls (Table 1). There was no difference seen in the overall admission rate (Figure 1a), but there was a significant delay in admission in cases compared to controls (8 [7][8][9][10][11][12][13][14][15][16][17][18] vs. 4 [2][3][4][5][6][7] days after positive swab, p = 0.03). Management through the pathway was not associated with a shorter length of hospital stay in those admitted (cases: 8 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] days, controls: 8 [6-10], p = 0.81).…”

Research progress of intelligent management model application in hospital-at-home care

“…The main goal of hospital-at-home care service is to reduce the incidence of adverse events related to patients and hospitalization [1], which can significantly reduce the economic burden of patients, readmission rates, and improve the diagnosis and treatment experience of patients who need to be hospitalized [2][3]. According to reports by Qin Zhaohui [4], Tu Wei et al [5], the traditional hospitalat-home care has the following problems: shortage of manpower for family doctors and nurses, insufficient professional training, and inability to fully meet the needs of patients for hospital-at-home cares.…”