Home First! Identification of Hospitalized Patients for Home-Based Models of Care

Link to article at PubMed

J Am Med Dir Assoc. 2020 Jul 25:S1525-8610(20)30487-4. doi: 10.1016/j.jamda.2020.05.061. Online ahead of print.


OBJECTIVES: To determine the proportion of hospitalized inpatients suitable for an acute and subacute home-based inpatient bed substitutive service, to examine the ability of treating teams to identify suitable patients for this service, and to examine potential barriers toward inpatients receiving home-based care.

DESIGN: Prospective point prevalence study over 2 days in April 2019; analysis of responses to survey questionnaires regarding the suitability for home-based care among inpatients with multiday admissions to acute and subacute wards in the Royal Melbourne Hospital (RMH), an Australian metropolitan tertiary referral center.

SETTING AND PARTICIPANTS: Ward treating teams, clinicians affiliated with the home-based service called RMH@Home, and inpatients who were subsequently identified as being suitable for home-based care.

MEASUREMENTS: Point prevalence and characteristics of inpatients suitable for a home-based bed substitutive service; identified by either treating teams or RMH@Home clinicians; and barriers to the provision of home-based care among ward inpatients.

RESULTS: Survey responses were received for 620 of 635 inpatients [median age 69 years (interquartile range 53-81), 53% male], of which 69 (11.1%) were identified as being suitable for home-based inpatient bed substitution care. Treating team clinicians identified 26 patients, clinicians affiliated with RMH@Home identified a further 43 suitable patients. The most commonly reported barrier (38.1%) toward receiving home-based care was functional disability impeding ability to live at home.

CONCLUSIONS AND IMPLICATIONS: A substantial proportion of hospitalized older patients could use home-based inpatient bed substitutive services. Clinicians experienced in home-based care are more skilled than ward-based clinicians in identifying suitable patients for this care model.

PMID:32723535 | DOI:10.1016/j.jamda.2020.05.061

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