Effectiveness of an in-home healthcare intervention for patients with advanced chronic respiratory disease

BACKGROUND: Advanced chronic diseases are a significant health problem. The aim of this study was to assess the effects of an in-home health care intervention program on emergency and hospital admissions in these patients.METHODS: A quasi-experimental study including non-concurrent one-year pre- and during intervention. The sample was composed of 104 patients (64 men; mean age 70.7±13.2 years [range 31-93]), of which 47 (45,2%) had neuromuscular disease; 35 (33.6%) had COPD; 11 (10.6%) obesity hypoventilation syndrome; 8 (7.7%) had restrictive lung disease; and 3 (2.9%) had other conditions. Follow-up was performed between 2004 and 2022. The home health care intervention program involved health care visits to patients at home on a monthly basis and as needed. A comparative analysis was performed of the frequency of respiratory exacerbations (based on emergency visits and hospital admissions) before and after inclusion in the intervention program.RESULTS: There were 10 deaths within the first year of follow-up, and 94 patients completed the program. Before the intervention, there were 96 and 101 emergency visits and hospital admissions, respectively, versus 55 and 54, after the intervention (P<0.01). The length of hospital stay was 14.3±23.7 days before the intervention vs. 5.4±12.7 after the intervention, P=0.001. The risk of readmission was higher in patients who had a previous admission (OR: 2.00 [95% CI: 1.34-2.98]); P=0.001) and in older patients (OR: 1.05 [95% CI: 1.01-1.09]; P=0.027).CONCLUSIONS: Our in-home care intervention program for patients with advanced chronic disease was effective in reducing the number of emergency visits and hospital admissions and length of hospital stay.