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[Post-acute and rehabilitation care in young patients with multiple comorbidities: An observational study]
S Hannane1, K Sacre1, J-F Alexandra1
1Université Paris-Diderot, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France.
Insights
This pilot program for post-acute care improved outcomes for complex patients with limited resources. Despite significant health challenges, most patients returned home and experienced reduced readmissions and mortality.
Area of Science:
- Internal Medicine
- Geriatrics
- Rehabilitation Medicine
Background:
- A specialized post-acute and rehabilitation care unit was established at Bichat Hospital, Paris, for patients under 75 with multiple comorbidities.
- This unit operates within the Department of Internal Medicine, focusing on complex patient needs.
Purpose of the Study:
- To report on the demographic factors, clinical characteristics, and outcomes of patients admitted to this pilot rehabilitation structure.
- To evaluate the effectiveness of the specialized unit in managing patients with complex health needs and limited socioeconomic resources.
Main Methods:
- A retrospective review of all consecutive adult patients admitted between May 2017 and May 2018.
- Analysis of demographic data, clinical characteristics, Charlson comorbidity index, length of stay, and patient outcomes at discharge and 1-year follow-up.
Main Results:
- The study included 61 patients (median age 61 years) with a median Charlson comorbidity index of 6.
- Most patients had significant socioeconomic challenges, including unemployment (83.6%) and low income (65.6%).
- At discharge, 85.4% of patients returned home, and 65.6% experienced complete resolution of health problems, associated with lower 1-year readmission and mortality rates.
Conclusions:
- The specialized unit successfully managed a high percentage of patients with complex health needs and limited access to care.
- Admission to this structure improved patient outcomes, including functional recovery and reduced hospital readmissions, despite patients' vulnerability.
Introduction:
A unique structure devoted to post-acute and rehabilitation care for patients under 75 with multiple comorbidities has been created within the Department of Internal Medicine, Bichat Hospital, Paris. We aim to report on demographic factors, clinical characteristics and outcomes of patients hospitalized in this pilot structure.
Methods:
All consecutive adult patients admitted between May 2017 and May 2018 were retrospectively reviewed.
Results:
Analysis was performed on 61 (61 [24-75] years-old) admitted patients. The median length of hospital stays was 108 [13-974] days. At admission, the median Charlson comorbidity index was 6 [0-12] predicting a 10-year survival of 21 [0-99]%. Most patients were unemployed (83.6%) and had very low-income (< national minimum wage in 65.6% of cases). At hospital discharge, most patients (85.4%) were able to return home. The complete resolution of health problems occurred in most cases (65.6%) and was associated with a lower probability of both hospital readmission and death 1-year after discharge.
Conclusion:
The structure served a high percentage of patients with major and complex health needs but limited access to care due to individual disabilities, low-income and underinsured status. However, despite major health disorders, functional limitations, and vulnerability, admission improved patient outcomes and reduced excess hospital readmissions in most cases.
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