The functioning of the Cuban home hospitalization programme: a descriptive analysis.
BACKGROUND
Over the last decades hospital at home (HaH) programmes have been set up in many, mainly European, countries. The Cuban HaH programme is not hospital driven, but the responsibility of the first line health services, and family doctors play a pivotal role.


METHODS
We analyse the structure and functioning of the Cuban programme. In this descriptive study, information was prospectively collected on HaH patients admitted between July 1st 2001 and June 30th 2002.


RESULTS
Admission rates varied between areas from 0.014 to 0.035 per person per year (ppy). The < 1 y and 1-4 y age groups had the highest admission rates. In one area the follow-up of pregnancy problems led to high 15-24 y and 25-49 y female admission rates (0,070 and 0,058 respectively). Respiratory affections were the most frequent reason for admission (32,6%), followed by early hospital discharge (16,0%) and gynaeco-obstetrical problems (10.8%). The median length of stay varied from 5 to 7 days between regions and from 5 days (early discharge) to 7 days (gynaeco-obstetrical problems) in function of the reason for admission. On average an HaH episode entailed 1.4 and 1.6 contacts per patient-day with the family doctor and nurse respectively.


CONCLUSIONS
Difference in admission criteria in function of geography, distance to the hospital, transport facilities, and staff factors, as well as differences in hospital policy on early discharge explain the observed variability. The programme plays an important role in the integrated approach to quality care in the Cuban health system, but could benefit from more uniform admission criteria.
De Vos
Pol
P
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. pdevos@itg.be
Barroso
Isabel
I
Rodríguez
Armando
A
Bonet
Mariano
M
Van der Stuyft
Patrick
P
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003462:Cuba; D019033:Delivery of Health Care, Integrated; D017598:Efficiency, Organizational; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D010348:Patient Care Team; D011247:Pregnancy; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014600:Utilization Review