Comprehensive Geriatric Hospital at Home: Adaptation to Referral and Case-Mix Changes During the COVID-19 Pandemic.
Marco Inzitari, Cristina Arnal, Aida Ribera and 4 others
PMID 36470320WHAT IT FOUND
Hospital-at-home services for older adults adapted to pandemic changes without worsening outcomes.
However, patients referred directly from the community achieved less functional recovery than those stepping down from hospital. Community referrals often involved more complex, frail patients.
Key findings
01Functional improvement and mortality did not differ significantly between prepandemic and pandemic periods after adjustment.
02Patients referred from primary care (step-up) had significantly lower functional improvement than those referred from hospital (step-down).
03The proportion of patients referred directly by primary care teams increased progressively during the pandemic.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study could not control for the severity or acuity of disease at admission, which may differ between referral pathways. Results may not be generalizable due to local contextual factors and specific relationships with primary care and after-hours providers in this Spanish system. The time periods were defined arbitrarily to balance operational context with sample size.
Declared interests
No specific conflicts of interest or funding sources were detailed in the provided text beyond the mention of public reimbursement for the service.
The easy way to misread this
Do not conclude that hospital-at-home care is ineffective for community referrals. The lower functional improvement in step-up patients likely reflects their greater baseline complexity and frailty, not a failure of the intervention itself. Adjusted mortality was not significantly different between pathways.