[Intermediate hospital care for subacute elderly patients as an alternative to prolonged acute hospitalization]. / Derivación de pacientes geriátricos subagudos a un hospital de atención intermedia como alternativa a la permanencia en un hospital general.

OBJECTIVE: We evaluated the rapid discharge of older patients with reactivated chronic diseases from an acute general hospital to an intermediate care hospital. METHODS: A cohort study was carried out. Compliance with predefined quality standards and patient selection were evaluated. RESULTS: Sixty-eight patients (mean age 82.6 years, 48.5% men) were discharged from the emergency department (69.1%) or medical wards (mean [SD] global length of stay 2.6 [2.9] days in acute wards and 1.5 [1.6] days in the emergency department). Mean post-acute length of stay (SD) was 11.4 (4.2) days. Fifty-six patients (82.4%) were discharged to their previous living situation (home or nursing home), two back to the emergency department, seven to long-term care, and three died. All quality standards were met. In a multivariate analysis, male gender and a higher risk of malnutrition were associated with an increased risk of not returning to the previous living situation (p <0.05). CONCLUSIONS: Intermediate care for selected patients with reactivated chronic diseases might represent an alternative to prolonged acute hospitalization.

[Integrated health care organizations: guideline for analysis]. / Organizaciones sanitarias integradas: una guía para el análisis.

There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.