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Gériatrie et Psychologie Neuropsychiatrie du Vieillissement

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Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers Volume 20, issue 2, 2022-06-01

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Authors
14 rue Vésale, Paris, France
Correspondance : M. De Stampa

Background

Nursing homes’ (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents’ needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals).

Methods

A retrospective study on 1,436 residents’ stays in the intervention of the Assistance Publique-Hôpitaux de Paris’HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d’Information (PMSI) data was used for the analysis.

Results

Residents were 88 years old with 69 % of women with functional disability and the care was mainly represented by the complex dressing (68 %). For the care pathway, 65 % of the referrers were from the NH and 35 % from the hospital settings, 33 % of the residents died at the end of the stay in the NH and 25 % were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). Discussion : Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.