[The need for palliative care in home care patients. Prospective observational study with the implementation of two algorithms]. / Il bisogno di cure palliative nei pazienti in cure domiciliari attraverso l'applicazione di due algoritmi. Studio osservazionale prospettico.

. The need for palliative care in home care patients. Prospective observational study with the implementation of two algorithms. INTRODUCTION: The early identification of patients with palliative care needs is crucial for defining appropriate care settings and interventions. OBJECTIVE: To detect the need for palliative care in home care patients and to compare two instruments: the SPICT™ and the I-CURPAL-029. METHODS: All new patients taken on in home care in the South-West and North-West Districts of the ASL Città di Torino between 27/12/2021 and 19/02/2022 were included and assessed with the two systems at intake, at two and six weeks. Data collected on patients: demographic characteristics, diagnosis, reason and duration of admission, reason for discharge, degree of autonomy and mobility, presence of cognitive and behavioural disorders, social support. RESULTS: 170 patients were included. At admission, 99 (58.2%) patients with SPICT™ and 84 (49.4%) with I-CURPAL-029 were assessed as needing palliative care; 78 (45.9%) by both instruments. Of the 13 with a need for specialist palliation, 8 were transferred to specialist palliative care. Changes in patients' conditions between controls were detected by both instruments and only affected 12.4% of the sample. SPICT™ and I-CURPAL-029 were sensitive in detecting the need for palliation. SPICT™ was suitable for the home context due to the presence of indicators on caregiving. CONCLUSIONS: Many patients in home care need palliative care. To support decisions for specialistic care, patients classified as palliative by SPICT™ could be assessed with I-CURPAL-029 to identify the need for specialist palliative care.

[Continuity of care: the concordance of discharge planning between public and private hospitals and district]. / Continuità assistenziale ospedale-territorio. Analisi della concordanza dei progetti di dimissione tra Ospedali/Case di cura e Distretti.

INTRODUCTION: A good post hospital discharge planning facilitates the discharge, improves patients' health conditions and decreases the social costs. AIM: To assess the agreement of the discharge settings suggested by the public or private hospitals and by the district. METHOD: A random sample of 318 over 1152 discharge reports send in 2013 by Hospitals to the District service of ASLTO2 - Piedmont Region was selected. RESULTS: The agreement for discharge planning between public hospitals and District was 57.4% (50% for private hospitals), with differences according to the discharge setting: 75.3% for Home care, 61.3% for Nursing Homes, 44.4% long term rehabilitation, 42.9% for the Hospice and only 7.4% for specialized Nursing Homes. Reasons for lack of agreement were an inappropriate assessment of patients or family resources and of discharge settings. CONCLUSIONS: The District is in a better position for assessing the range services to be offered the to patients, their living and family conditions and thus, to identify the most suitable post discharge settings.

Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?

BACKGROUND: Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30 days, or routine discharge care. The aim of this study was to evaluate whether a hospital DPCH that was compared with routine care, improved patients' outcomes in terms of reduced hospital readmission and mortality rates in patients aged 64 years and older. METHODS: In a retrospective observational cohort study a sample of 380 subjects aged 64 years and over was examined. Participants were discharged from the hospital S. Giovanni Bosco in Turin, Italy from March 1st, 2005 to February 28th, 2006. Of these subjects, 107 received routine discharge care while 273 patients were referred to care-home (among them, 99 received a long-term care intervention (LTCI) afterwards while 174 did not). Data was gathered from various administrative and electronic databases. Cox regression models were used to evaluate factors associated with mortality and hospital readmission. RESULTS: When socio-demographic factors, underlying disease and disability were taken into account, DPCH decreased mortality rates only if it was followed by a LTCI: compared to routine care, the Hazard Ratio (HR) of death was 0.36 (95% Confidence Interval (CI): 0.20 - 0.66) and 1.15 (95%CI: 0.77 - 1.74) for DPCH followed by LTCI and DPCH not followed by LTCI, respectively. On the other hand, readmission rates did not significantly differ among DPCH and routine care, irrespective of the implementation of a LTCI: HRs of hospital readmission were 1.01 (95%CI: 0.48 - 2.24) and 1.18 (95%CI: 0.71 - 1.96), respectively. CONCLUSION: The use of DPCH after hospital discharge reduced mortality rates, but only when it was followed by a long-term health care plan, thus ensuring continuity of care for elderly participants.