Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

BMC Geriatrics

François-Xavier Duchateau¹  Amélie Carpentier²  Nicolas Peschanski³  Gustave Toury⁴  Anne-Laure Feral-Pierssens⁵  Philippe Juvin⁶  Magali Kraif⁷  Fatima Sehimi⁸  Yonathan Freund⁹  Clément Carbonnier^1,10  Saïd Laribi^1,11 

[1] Emergency Medical Service, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Garches, France;Emergency department and Emergency Medical Service, Jean-Bernard Hospital, Centre Hospitalier de Valenciennes, Valenciennes, France;Emergency department, Charles Nicolle University Hospital, Rouen, France;Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France;Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France;IMProving Emergency Care academic federation, Paris, France;CR-CSIS, Université de Sherbrooke, Longueuil, Québec, Canada;Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France;IMProving Emergency Care academic federation, Paris, France;Université de Paris, Paris, France;Emergency department, La Timone hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France;Emergency department, Saint-Antoine hospital, Assistance Publique Hôpitaux de Paris, Paris, France;IMProving Emergency Care academic federation, Paris, France;Sorbonne Université, Paris, France;Emergency department, Pitié-Salpétrière hospital, Assistance Publique Hôpitaux de Paris, Paris, France;Sciences Po, LIEPP, Paris, France;Chaire en fiscalité et finances publiques, Université de Sherbrooke, Longueuil, Canada;Tours University, Tours, France;Emergency department, Tours University Hospital, Tours, France;

关键词: Elderly;    Healthcare access;    Loss of autonomy;    Home services;    Emergency care;   

DOI  :  10.1186/s12877-020-01742-1

来源: Springer

【 摘 要 】

BackgroundFor the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources’ use and patients’ outcome.MethodsA multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for “having difficulties coping at home”. The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints.ResultsOne thousand one hundred sixty-eight patients were included, median age 86(83–89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68–2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65–1.30]). Assisted patients had a lower risk of being admitted for “having difficulties coping at home” (OR = 0.59;95%CI [0.38–0.92]).ConclusionProfessional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications.Trial registrationClinicaltrial.gov - NCT02900391, 09/14/2016, retrospectively registered

【 授权许可】

CC BY