Usability of a mobile application for health professionals in home care services: a user-centered approach.

The use of mobile devices by healthcare professionals has led to rapid growth in the development of mobile healthcare applications designed to improve healthcare services. This study was conducted to assess the acceptability and usability of a mobile application for health professionals in relation to their work in hospitalization at home. A mixed methods approach was used. Acceptance, included the satisfaction of the professionals, attitudes toward using the application, and intention or willingness to continue using the application. Usability tests were performed in laboratory analyzing five controlled clinical tasks, and the interaction of the participants with the mobile application was based on the six basic facial expressions published by the American Psychological Association. Perceived satisfaction was assessed using the computer system usability questionnaire. Thirty-two participants completed the task scenarios and questionnaire. More than 90 per cent of participants were able to complete the tasks with only some difficult with vital signs. Satisfaction had a score of 6.18/7 (SD: 0.76), and recommendation of the mobile application had a score of 6.21/7 (SD: 0.81). This study showed a significant usability and acceptability of this mobile application, in terms of effectiveness, efficiency, and satisfaction.

Repercusión en la capacidad funcional del ingreso en Hospitalización a Domicilio en pacientes mayores de 80 años / Impact of admission at Hospital at Home on the functional status in patients older than 80 years

INTRODUCCIÓN: La hospitalización por enfermedad aguda en pacientes ancianos puede significar la aparición de deterioro funcional hospitalario (DFH). Por su elevada frecuencia y las graves consecuencias derivadas, analizamos el deterioro funcional en pacientes ingresados en una unidad de Hospitalización a Domicilio (HAD). MÉTODO: Estudio descriptivo retrospectivo de pacientes ≥ 80 años ingresados en HAD. Se obtuvieron variables demográficas y sociofamiliares, procedencia del ingreso, duración del ingreso previo e ingreso en HAD, variables clínicas y comorbilidad. Se recogió situación funcional basal, al ingreso, al alta y a los 3 meses según índice de Barthel (IB). Se excluyeron las estancias cortas, los paliativos, los fallecidos, aquellos con IB previo < 10 y los reingresos como motivo de alta. RESULTADOS: Se incluyeron 168 pacientes ≥80 años, 52.4% hombres. El 71.4% procedentes de urgencias. Los pacientes institucionalizados presentaron peor resultado funcional. El 40,5% presentó pérdida funcional (PF) al ingreso. Al alta, mejoraron 1.2%, se mantuvieron el 59,3% y empeoraron el 39,4%. La PF al alta es menor si la estancia hospitalaria es ≤ 2 días y la estancia total <7 días. El uso de sonda vesical se asocia a peor resultado funcional al alta y se mantiene a los 3 meses. CONCLUSIONES: La HAD puede reducir el DFH si se acorta la estancia hospitalaria previa

INTRODUCTION: Hospitalization for acute illness in elderly patients may precipitate the appearance of hospital functional impairment (HFI). Due to its high frequency and the serious consequences derived, we analysed functional results in patients admitted to a Hospital at Home (HAH) unit. METHOD: Retrospective descriptive study of patients ≥ 80 years admitted to HAH. We collected sociodemographic characteristics, source of referral, previous hospital stay and HAH stay, clinical assessment and comorbidity. Functional status previous, at admission, at discharge and after 3 months was collected according to the Barthel index (BI). Short stays, palliative care, deaths, those with a previous BI <10, and readmissions as a reason for discharge were excluded. RESULTS: 168 patients ≥80 years old, 52.4% men, were included. 71.4% admitted from the emergency department. Institutionalized patients presented worse functional results. 40.5% presented functional loss (FL) at admission. At discharge, they improved 1.2%, remained 59.3% and worsened 39.4%. The FL at discharge is lower if the previous hospital stay is ≤ 2 days and the total stay <7 days. The use of bladder catheter is associated with a worse functional result at discharge and is maintained at 3 months. CONCLUSIONS: HAH can reduce HFI if the previous hospital stay is shortened

10 años de hospitalización a domicilio en el entorno de un hospital comarcal / 10 years of hospital at home in a regional hospital environment

INTRODUCCIÓN: La Hospitalización a Domicilio (HAD) se inició en nuestra zona a finales de 2007, actualmente consta de 3 unidades, 30 camas y tiene una cobertura territorial del 80%. La modalidad de ingreso es mixto, evitación de ingreso y alta precoz. OBJETIVO: analizar los resultados de HAD en los últimos 10 años en cuanto a eficacia y eficiencia. MÉTODO: Análisis retrospectivo de los pacientes ingresados en HAD (enero 2009-Diciembre 2018) para definir tipología de paciente y procedencia, evaluar indicadores de estancia media, retorno al hospital, reingreso a los 30 días, mortalidad y coste comparado con hospitalización convencional. RESULTADOS: Se han realizado 6.033 altas. El 86% de los pacientes ingresaron por un proceso médico con predominio de las enfermedades del aparato respiratorio (43,7%). La modalidad de evitación de ingreso supuso el 79% de los ingresos en HAD. La estancia media en HAD fue de 7,1 días y el retorno al hospital por complicaciones del 4,1%. La mortalidad fue del 2,3% y los reingresos por cualquier motivo en los 30 días siguientes al alta de HAD del 12,2%, ambos inferiores a los resultados de las unidades de hospitalización de Medicina Interna. La gravedad según el sistema de clasificación APRDRG de los pacientes ingresados en HAD fue significativamente superior a la encontrada en la Unidad de Corta Estancia pero menor que en las unidades de hospitalización de Medicina Interna, tal como era de esperar. El coste de estructura por día de estancia en HAD fue, aproximadamente, 3 veces inferior al de hospitalización convencional. CONCLUSIONES: HAD ha sido una alternativa útil a la hospitalización convencional, principalmente para patología médica de pacientes que precisando ingreso, no necesitaban toda la infraestructura hospitalaria

INTRODUCTION: Hospital at Home (HAH) started in our area at the end of 2007; currently it consists of 3 units, 30 beds and 80% territorial coverage. It has two main aims: to avoid unnecessary hospital admission and to allow early discharge. OBJECTIVE: to analyze the results of HAH in the last 10 years in terms of effectiveness and efficiency. METHOD: Retrospective analysis of patients discharged in HAH (January 2009-December 2018) to define patient typology and source of admission, to evaluate indicators of length of stay, return to hospital, 30-day readmission rate, mortality rate, severity according to the APRDRG classification system and cost compared to conventional hospitalization. RESULTS: 6,033 patients have been discharged. 86% of patients were admitted through a medical process with a predominance of respiratory diseases (43.7%). The modality of Hospital admission avoidance was 79% of the admissions in HAH. The average length of stay in HAH was 7.1 days; the return to the hospital due to complications was 4.1%. Mortality rate was 2.3%, and the 30-day readmission rate was 12.2 %, both lower than the average of the Internal Medicine units. The severity according to the APRDRG classification system of patients admitted in HAH was significantly higher than in the Short Stay Hospital Unit but less than conventional hospitalization in Internal Medicine Units, as expected. The cost of structure per day of stay in HAH is approximately 3 times lower than conventional hospitalization. CONCLUSIONS: HAH has been a useful alternative to conventional hospitalization, mainly for medical pathology of patients who, requiring admission, did not need the entire hospital infrastructure

Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación hospitalaria / Evaluation of an intervention program in Nursing Homes to reduce hospital attendance

Objetivos. Este estudio describe los resultados de un programa de intervención asistencial en residencias geriátricas (RG) y su repercusión en las visitas a urgencias, ingresos hospitalarios urgentes y gasto farmacéutico. Material y métodos. Intervención comunitaria no aleatorizada en RG con un grupo control. Se implanta progresivamente desde 2007 a 2009 en 10 RG (857 plazas) que participaron voluntariamente. Formaron el grupo control 14 RG (1.200 plazas), las que declinaron participar y las que no estaban asignadas a nuestros centros de salud. La intervención consistió en la valoración geriátrica integral y visitas de seguimiento por personal especializado, revisión y adecuación del tratamiento farmacológico, gestión de casos y formación del personal. Resultados. En las RG intervenidas la frecuentación a urgencias disminuyó pasando de1.165‰ (IC 95% 1.100-1.240) en 2006 a 674‰ (IC 95% 620-730) en 2009, mientras que en las no intervenidas se incrementó de 1.071‰ (IC 95% 1.020-1.130) a 1246‰ (IC 95% 1.190-1.310). Los ingresos hospitalarios urgentes se redujeron de 48,4% (IC 95% 45-52) en 2006 a 32,1% (IC 95% 29-35) en 2009, mientras que en el grupo control se incrementó de 43,5% (IC 95% 41-46) a 55,8% (IC 95% 53-59). Se redujo un 9,0% el gasto de farmacia en las RG intervenidas frente a un incremento del 11,9% en las RG control. Conclusiones. El programa de intervención ha demostrado ser efectivo para reducir la frecuentación hospitalaria y de urgencias en los pacientes institucionalizados y permite racionalizar los costes de farmacia(AU)

Objectives. This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure. Material and methods. This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training. Results. In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165‰ (95%CI 1100-1240]) in 2006 to 674‰ (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246‰ (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group. Conclusions. The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs(AU)

[Evaluation of an intervention program in nursing homes to reduce hospital attendance]. / Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación hospitalaria.

OBJECTIVES: This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure. MATERIAL AND METHODS: This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training. RESULTS: In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165‰ (95%CI 1100-1240]) in 2006 to 674‰ (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246‰ (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group. CONCLUSIONS: The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs.