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

Seok M Lim; Louis Island; Adam Horsburgh; Andrea B Maier

doi:10.1016/j.jamda.2020.05.061

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

J Am Med Dir Assoc. 2021 Feb;22(2):413-417.e1. doi: 10.1016/j.jamda.2020.05.061. Epub 2020 Jul 25.

Authors

Seok M Lim¹, Louis Island¹, Adam Horsburgh², Andrea B Maier³

Affiliations

¹ Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
² The Royal Melbourne Hospital, Parkville, Victoria, Australia.
³ Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands. Electronic address: andrea.maier@unimelb.edu.au.

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

Abstract

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.

Keywords: Aged; delivery of health care; home care services; hospitals; patient discharge.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia
Female
Home Care Services*
Hospitalization*
Humans
Inpatients
Male
Prospective Studies