[Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care].
BACKGROUND
The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care.


METHODS
Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams).


RESULTS
506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital.


CONCLUSIONS
The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care.
San José Laporte
A
A
Servicio de Medicina Interna, Hospital Universitario Valle Hebron, Barcelona, España. asanjose@vhebron.net
Pérez López
J
J
Alemán Llansó
C
C
Rodríguez González
E
E
Chicharro Serrano
L
L
Jiménez Moreno
F X
FX
Ligüerre Casals
I
I
Vélez Miranda
M C
MC
Vilardell Tarrés
M
M
D000368:Aged; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D013030:Spain