[Proposing a workload indicator for hospital at home patients in Osakidetza - Basque Public Health Service]. / Propuesta de un indicador de cargas de trabajo en la atención de pacientes en hospitalización a domicilio de Osakidetza ­ Servicio Vasco de Salud.

INTRODUCTION AND OBJECTIVES: The Hospital at Home (HaH) setting currently lacks adequate workload indicators. This study suggests an indicator that can help in improving professional resources allocation. MATERIALS AND METHODS: Prospective data was collected during May 2021 from patients treated in nine HaH units of Osakidetza-Basque Health Service (North of Spain). Direct care and travel times of healthcare staff was recorded. Data on inpatient days, number of visits, sociodemographic variables, health status, and patient pathologies, among others, were collected. The proposed indicator encompasses both the average visit time and the visit rates. It is called intensity and represents the average daily workload time per patient. RESULTS: A total of n = 1,171 users were included in the analyses. Their mean age was 69.8 years, 45.5% were women and 25% lived more than 12 km away from the corresponding HaH unit. Workload variations were observed for nursing-only and medical-nursing teams, depending on the type of day and patient classification group. The average nursing-only teams workload time on working days was 10.82 min and on non-working days it was 14.78 min. The average workload time for medical-nursing teams, during the same days, was 20.40 min and 4.59 min, respectively. It was observed that certain patient types, like those in palliative care, represented a high workload for medical-nursing teams on working days. CONCLUSIONS: The intensity indicator can help answering the question of how many patients can be assigned to a professional. It can also be used to adjust the staffing needs of the HaH units.

[Factors associated with the hospital at home workload: A Delphi consensus study]. / Factores relacionados con la carga de trabajo en hospitalización a domicilio: estudio de consenso Delphi.

OBJECTIVES: To identify and prioritize a list of factors that contribute to the workload of the hospital at home (HaH) professionals. MATERIAL AND METHODS: A qualitative methodology study performed between January and December 2019 in the 10 HAH units of the Basque Country. The data were obtained in 4phases: 1. Systematic literature search and review; 2. Expert group meeting; 3. Consensus method: Delphi technique (2 survey rounds) and nominal group meeting; 4. Meeting of the research team. RESULTS: In the systematic literature search and review 85 factors were initially identified. These were reduced to 38 after the 8-person expert group meeting, in which 10 new factors were added. After the 2 Delphi rounds (106 and 57 professionals, respectively), 17 factors were maintained and 12 remained in doubt. The latter were evaluated at the nominal group meeting, consisting of 13 professionals who decided to eliminate 5 factors, include 3, and keep 3 as doubt. After the 8-person research team meeting, 14 potential factors were finally selected. They are related to the place of residence, the health state and social situation of the patients, as well as the health care provided at home. CONCLUSIONS: The identified factors could serve for improving the organization and optimize the daily word of the HaH professionals.

[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]. / Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos.

OBJECTIVES: To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. PATIENT AND METHOD: Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. RESULTS: A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). CONCLUSIONS: Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD.

Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos / Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes

Objetivos. Analizar la efectividad, situación respiratoria, servicios de procedencia, causas de reingreso y evolución de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) agudizada en una Unidad de Hospitalización a Domicilio (HaD). Pacientes y método. Estudio de pacientes con EPOC agudizada atendidos en la Unidad de HaD de Vitoria-Gasteiz entre marzo de 1999 y octubre de 2004, donde el ingreso hospitalario es recomendado tras valoración médica. Variables estudiadas: edad, sexo, estancia media, saturación de oxígeno o gasometría arterial, volumen espiratorio forzado en el primer segundo (FEV1) basal, grado de disnea (basal y actual), enfermedades coexistentes, causas de la agudización, servicios de procedencia, utilización de nebulizadores, oxigenoterapia y medicación intravenosa y evolución (altas/ingresos/fallecimientos). Analizamos el número de visitas a Urgencias y los ingresos hospitalarios 3 meses antes y 3 meses después de la intervención de HaD. Resultados. Trescientos dos pacientes que generaron 522 casos con EPOC agudizada fueron aceptados. El 81% eran hombres. La mediana de la estancia fue de 11 días (rango: 1-111). En 396 (76%) casos se dio el alta desde HaD. Ciento once (21%) tuvieron que ser hospitalizados por diferentes causas y 13 (2,5%) fallecieron. El 43 % procedían del Servicio Respiratorio y el 39% de Urgencias. El FEV1 medio fue de 45,4. El 89% de los pacientes tenían disnea 3-4/4 en el momento de ser atendidos. El 9% de los pacientes tuvieron neumonía. Durante los 90 días posteriores al alta por HaD el número de visitas a Urgencias y de ingresos disminuyó significativamente (p < 0,001). Conclusiones. Nuestros datos confirman que la HaD es una buena alternativa a la hospitalización convencional para el manejo de pacientes con EPOC agudizada (AU)

Objectives. To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. Patient and method. Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. Results. A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). Conclusions. Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD (AU)

[Brain lesions in patients with acquired immunodeficiency syndrome]. / Lesiones cerebrales en pacientes con síndrome de inmunodeficiencia adquirida.

During a period of 3 years 14 patients with AIDS and CNS focal lesions documented by CT scan were evaluated. All patients received empirical treatment against Toxoplasma. The aim of the study was to determine the prevalence of the different etiologies of the neurologic lesions as well as to evaluate the usefulness of routine cerebral biopsy before establishing empiric antitoxoplasma treatment in a population of AIDS patients with a high incidence of drug addiction. Eleven patients developed histologic and clinical criteria of cerebral toxoplasmosis, one patient presented progressive multifocal leukoencephalopathy, and in the remaining two patients the etiologic diagnosis could not be established. Only one patient presented multiple etiologic lesions and in no cases the presence of mycobacteria or fungi could be demonstrated in the cerebral tissue. The overall percentage of responses to the empiric antitoxoplasma treatment was 42%. This percentage increased to 54% if patients with coma were not included in the analysis. Cumulated mortality of the entire group was 78.5%. It is concluded: 1) the predominance of Toxoplasma gondii as a cause of cerebral lesions in our AIDS population; 2) the acceptable percentage of response to empiric antitoxoplasma treatment in non-comatose patients, and 3) the high overall mortality rate in these patients. It is therefore suggested that routine cerebral biopsies will not be justified as initial diagnostic approach in HIV positive patients with focal CNS lesions.