The content of this week's article has been developed, over the past few years, with my colleague and friend Miquel Àngel Mas (@DrMqAgMas), a geriatrician, former PhD student in our research group and currently a member of the expert nucleus in chronicity of the Gerència Territorial Metropolitana Nord de l'Institut Català de la Salut. We’ll discuss the subject from two points of view in the hope of generating interest and debate among the blog followers.
Our health and social system experiences periods of rethinking, mainly due to the changing requirements in the need of attention of older adults. This fact suggests that the approach to problems solving from the big acute hospitals, as structures that works separately from the community, loses centrality. The logic that follows is the evolution towards increasingly integrated systems, adapted to the different territories, with primary care and attention to the community in the middle. As Professor Dennis L. Kodner said in his classic - Integrated care: meaning, logic, applications, and implications - without a discussion at different levels, all aspects of the provision of attention suffer: patients lose (and get lost), the services are not provided correctly (or arrive late), the quality and the satisfaction of the patients goes down and the potential for sustainability of the system diminishes.
From this viewpoint, the integrated redesign of person-centred care trajectories in health crises (often presented in the form of exacerbations of chronic conditions) should be based on two key points: the first would be to plan from the perspective that the centre of the provision of services must be the community, and it’s from here where strategies adapted to risk stratification must be defined; the second would be to determine that referral to the emergency room or acute hospital admission doesn’t always have to be the first option, since we have several alternatives to the conventional admission.
From a geriatric perspective, the health care modality of home-based hospitalization, or hospital at home, as an alternative to acute and sub-acute or post-acute hospitalization, is a point to redefine new paradigms of crisis management in patients vulnerable to conventional hospitalization, due to frailty, multi-morbidity or advanced diseases and complex needs. If we are able to validate comprehensive complex interventions outside our hospitals, we can open windows to provide integrated solutions in the home and in the nursing homes, both for medical crises and for disabling crises (such as an hip fracture or a stroke) based on a collaborative work between geriatrics and primary care. Only then can we offer patients the value of complementing the longitudinal perspective of the primary care professionals, who know the person throughout its history and in its context, with the specialized resolution by a team specialized in geriatrics and geriatric rehabilitation. This team, as in any other hospitalization, carries out an intensive and time-limited intervention over time, which usually ends with the resolution of the crisis and the reintegration of the patients cared for in the usual community life.
In our system, we have a great opportunity to make home hospitalization one of the most solid alternatives to hospital admission for a very large range of health crises. In all the links of this article the reader will be able to contrast its effectiveness and efficiency, both in international studies and in studies that we ourselves have developed to adapt these schemes in the Catalan context. In this sense, the consolidation of the integral model of home hospitalization as a multi-purpose modality in complex crises, both for the substitution of hospital admission and for the reduction of hospital stay, cannot be effective if it does not start from the multiple needs of elderly patients, both during the acute crises and the post-acute transitions. This approach should be in line with the patient’s will to be cared for in his/her environment, if feasible and safe, and following the logic of the urgent need of a more integrated system.
From this viewpoint, the integrated redesign of person-centred care trajectories in health crises (often presented in the form of exacerbations of chronic conditions) should be based on two key points: the first would be to plan from the perspective that the centre of the provision of services must be the community, and it’s from here where strategies adapted to risk stratification must be defined; the second would be to determine that referral to the emergency room or acute hospital admission doesn’t always have to be the first option, since we have several alternatives to the conventional admission.
From a geriatric perspective, the health care modality of home-based hospitalization, or hospital at home, as an alternative to acute and sub-acute or post-acute hospitalization, is a point to redefine new paradigms of crisis management in patients vulnerable to conventional hospitalization, due to frailty, multi-morbidity or advanced diseases and complex needs. If we are able to validate comprehensive complex interventions outside our hospitals, we can open windows to provide integrated solutions in the home and in the nursing homes, both for medical crises and for disabling crises (such as an hip fracture or a stroke) based on a collaborative work between geriatrics and primary care. Only then can we offer patients the value of complementing the longitudinal perspective of the primary care professionals, who know the person throughout its history and in its context, with the specialized resolution by a team specialized in geriatrics and geriatric rehabilitation. This team, as in any other hospitalization, carries out an intensive and time-limited intervention over time, which usually ends with the resolution of the crisis and the reintegration of the patients cared for in the usual community life.
In our system, we have a great opportunity to make home hospitalization one of the most solid alternatives to hospital admission for a very large range of health crises. In all the links of this article the reader will be able to contrast its effectiveness and efficiency, both in international studies and in studies that we ourselves have developed to adapt these schemes in the Catalan context. In this sense, the consolidation of the integral model of home hospitalization as a multi-purpose modality in complex crises, both for the substitution of hospital admission and for the reduction of hospital stay, cannot be effective if it does not start from the multiple needs of elderly patients, both during the acute crises and the post-acute transitions. This approach should be in line with the patient’s will to be cared for in his/her environment, if feasible and safe, and following the logic of the urgent need of a more integrated system.
No comments:
Post a Comment