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The functioning of the Cuban home hospitalization programme: a descriptive analysis
Pol De Vos1, Isabel Barroso, Armando Rodríguez
1Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. pdevos@itg.be
Insights
The Cuban hospital at home (HaH) program, managed by primary care, shows varied admission rates and reasons, with respiratory issues most common. Uniform admission criteria could enhance this vital healthcare service.
Area of Science:
- Healthcare Management
- Public Health Policy
- Primary Care Services
Background:
- Hospital at Home (HaH) programs are established globally, primarily in Europe.
- The Cuban HaH model is unique, being managed by primary health services, not hospitals.
- Family doctors are central to the functioning of the Cuban HaH program.
Purpose of the Study:
- To analyze the structure and operational aspects of the Cuban Hospital at Home (HaH) program.
- To identify patient demographics, admission reasons, and length of stay within the Cuban HaH system.
Main Methods:
- A descriptive study design was employed.
- Prospective data collection on HaH patients admitted between July 1, 2001, and June 30, 2002.
- Analysis of admission rates, reasons for admission, and patient contact frequency.
Main Results:
- Admission rates ranged from 0.014 to 0.035 per person per year, with highest rates in the youngest age groups.
- Respiratory conditions (32.6%) were the leading cause for admission, followed by early hospital discharge (16.0%) and gynecological-obstetrical issues (10.8%).
- Median length of stay varied by region (5-7 days) and reason for admission, with an average of 1.4 family doctor and 1.6 nurse contacts per patient-day.
Conclusions:
- Variability in admission rates is attributed to geographical factors, hospital policies, and staff considerations.
- The HaH program is integral to Cuba's quality healthcare approach.
- Standardizing admission criteria could further optimize the Cuban HaH program's effectiveness.
Background:
Over the last decades hospital at home (HaH) programmes have been set up in many, mainly European, countries. The Cuban HaH programme is not hospital driven, but the responsibility of the first line health services, and family doctors play a pivotal role.
Methods:
We analyse the structure and functioning of the Cuban programme. In this descriptive study, information was prospectively collected on HaH patients admitted between July 1st 2001 and June 30th 2002.
Results:
Admission rates varied between areas from 0.014 to 0.035 per person per year (ppy). The < 1 y and 1-4 y age groups had the highest admission rates. In one area the follow-up of pregnancy problems led to high 15-24 y and 25-49 y female admission rates (0,070 and 0,058 respectively). Respiratory affections were the most frequent reason for admission (32,6%), followed by early hospital discharge (16,0%) and gynaeco-obstetrical problems (10.8%). The median length of stay varied from 5 to 7 days between regions and from 5 days (early discharge) to 7 days (gynaeco-obstetrical problems) in function of the reason for admission. On average an HaH episode entailed 1.4 and 1.6 contacts per patient-day with the family doctor and nurse respectively.
Conclusion:
Difference in admission criteria in function of geography, distance to the hospital, transport facilities, and staff factors, as well as differences in hospital policy on early discharge explain the observed variability. The programme plays an important role in the integrated approach to quality care in the Cuban health system, but could benefit from more uniform admission criteria.
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