The role of hospital-at-home in the health crises management of high-need older populations: views from the ProPCC Programme in Catalonia

The health systems worldwide have a huge challenge for the next decades: due to recent advances in care we are facing a complex scenario where there are groups of high-need vulnerable populations that are living with frailty and multimorbidity. In these cases some authors urge to redesign services (1) in order to facilitate proactive integrated care responses in the community, where home-based multidisciplinary teams, such as hospital-at-home (2), reablement at home, or hospice-at-home, play an important role in the management of health crises (3).

 In the North of Barcelona region, the Metropolitana Nord Chronic Care Management Team (4) at Institut Català de la Salut (ICS), have designed two projects for supporting integrated care to frail populations (ProFràgil project) and to high-need populations (ProPCC project). ICS (Catalan Health Institute) is the main public health provider in Catalonia, and in our area, it manages care for up to 1,4 M people from 71 municipalities, through 64 Primary Care Teams and the Germans Trias i Pujol University Hospital.

 Our team created in 2018, by leading a collaboration between clinicians, patients, and caregivers, the Community Based Integrated Care Programme for People with Complex Chronic Conditions (ProPCC Programme) (5). It was tailored to high-need high-cost individuals at high risk of hospital admission, by targeting complex chronic patients and advanced illnesses patients, and by providing them anticipatory care based on person-centred best practices for the whole care pathway, including end-of-life.

The ProPCC programme implementation started in May 2018 by using a unique case management process for the whole region, shared by different multidisciplinary teams from primary and secondary care, with the objectives of increasing the time spent at home and improving the resource use adequacy.

In the WHAHC held in Barcelona in 2023, we presented a study that analysed preliminary results of the role of hospital-at-home in the health crisis management of the ProPCC Programme, based on health crises resolution, 30-day readmission and 30-day mortality. We focused on the Admission Avoidance pathway (46% of cases) due to the importance of managing health crises in the community without conventional hospital admission (notice that one of two Admission Avoidance cases were referred to hospital-at-home directly from primary care case management teams). Main trigger diagnosis were respiratory and urinary infections, followed by heart failure. We evidenced health crises resolution in 8 of 10 cases. On the other side, the profile of Early Supported Discharge cases was more heterogeneous and 30-day readmission was higher than in the Admission Avoidance pathway, in part due to complexity of postacute cases.

The results of our preliminary approach suggest that hospital-at-home services are a key element for the care of high-need populations due to their ability to respond to heath crises management in the community, by using a collaborative methodology shared with other services involved in the integrated care strategy.

ABOUT THE AUTHOR

Miquel À. Mas, MD PhD, geriatrician, Metropolitana Nord Chronic Care Management Team, 
on behalf of all the participants in the ProPCC project

Related links: 

• Link 1: https://academic.oup.com/ageing/article/46/6/925/3887243?login=false
• Link 2: https://www.elsevier.es/es-revista-revista-espanola-geriatria-gerontologia-124-articulo-developing-new-hospital-at-home-models-based-S0211139X22001810
• Link 3: https://www.jamda.com/article/S1525-8610(18)30333-5/fulltext
• Link 4: https://germanstriashospital.cat/en/chronic-care-management-team
• Link 5: https://ijic.org/articles/10.5334/ijic.5653