Hospital-at-home integrated care programme for older patients with orthopaedic conditions: Early community reintegration maximising physical function.
OBJECTIVE
Older citizens with orthopaedic conditions need specialised care for the facilitation of early community reintegration and restitution of physical function. We introduced a new community care programme as an alternative to usual hospital rehabilitation for orthopaedic patients.


METHODS
This was an observational study of a cohort of older orthopaedic patients attending a hospital-at-home integrated care programme (HHU), compared with a contemporary cohort of users of a geriatric rehabilitation unit (GRU) in the urban area of Badalona, Catalonia, Spain.


METHODS
Functional gain at discharge was measured using the Barthel Index (BI). Other outcomes were: length of intervention (days), rehabilitation efficiency and discharge destination.


RESULTS
Over the 2 years of the study we assessed 270 patients (69 at HHU; 201 at GRU). We found no significant differences in baseline characteristics between HHU and GRU groups-mean (IQR) or % age 83 (79-87) vs. 84 (79-88), cognitive impairment 27.5% vs. 24.9%, functional decline 40 (31-48) vs. 43 (32-58). Overall, we found no statistically significant differences between HHU and GRU groups on functional gain: 35 (22-45) vs. 32 (18-46), and discharge home 85.5% vs. 86.1%. Length of intervention was shorter in the HHU group, 43 (32-56) vs. 57 (44-81); p<0.01, for hip fracture patients. In a multivariate analysis, the adjusted mean difference in rehabilitation efficiency between HHU and GRU groups in the hip fracture subgroup was 0.27 (0.09 to 0.46); p=0.004.


CONCLUSIONS
This hospital-at-home service obtained similar clinical results to the usual hospital-based rehabilitation care, and for hip fracture patients attending that service, rehabilitation efficiency was better.
Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain. Electronic address: drmqagmas@gmail.com.
Miquel Àngel
MÀ
Mas
Department of Physical Medicine and Rehabilitation, Corporación Fisiogestión, Spain.
Conxita
C
Closa
Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain.
Sebastià J
SJ
Santaeugènia
Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
Marco
M
Inzitari
Cardiovascular Epidemiology Unit, Cardiology Department, CIBERESP, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain; Stroke Programme, Department of Health of Catalonia, Spain.
Aida
A
Ribera
Stroke Programme, Department of Health of Catalonia, Spain.
Miquel
M
Gallofré
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D019033:Delivery of Health Care, Integrated; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006761:Hospitals; D006801:Humans; D008297:Male; D009985:Orthopedics; D013030:Spain
Disability; Frailty; Hospital-at-home; Integrated care; Orthogeriatrics