학술논문
Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study
Document Type
Clinical report
Author
Feral-Pierssens, Anne-Laure; Toury, Gustave; Sehimi, Fatima; Peschanski, Nicolas; Laribi, Saïd; Carpentier, Amélie; Kraif, Magali; Carbonnier, Clément; Duchateau, François-Xavier; Freund, Yonathan; Juvin, Philippe; Serre, Patrice; Arnaud, Aurélie; Dugat, Edouard; Occelli, Céline; Lanoux, Thomas; Jacquet, Edouard; Moretto, Céline; Devillard, Arnaud; Bordais, Aurélia; Maurin, Olivier; Caffier, Aurélie; Duchenne, Jonathan; Gillet, Stéphane; Milojevitch, Ester; Tissier, Cindy; Kilic, Sunde; Uchlinger, Véronique; Gonzalez, Nicolas; Lacoste, Vincent; Pouzoulet, Sébastien; Khoury, Abdo; Marguet, Philippe; Zamour, Claude; Proust, Arnaud; Dessena, Anastasia; Saura, Frédéric; Schindler, Aurélie; Gelin, Emilie; Tendron, Ludivine; Cailleux, Isabelle; Basso, Marie-Hélène; Houze-Cerfon, Vanessa; Oudet, Julie; Ah-Koon, Bernard; Babet, Thierry; Bereau, Justine; Vally, Rishad; Souchaud, Emilie; Scouarnec, Catherine; De Stabenrath, Olivier; Vuillot, Olivier; Giraud, Isabelle; Bebien, Laurent; Chauvel, Nicolas; Le Normand, Thomas; Rouchy, Cécile; Arnault, Isabelle; Brenkmann, Vivien; Viglino, Damien; Maiello, Ernest; Matas, Olivier; Lemarchand, Rémy; Duffait, Yves; Bonhomme, Cécile; Martinez, Mikaël; Viallon, Alain; Legoff, Quentin; Blonstein, Benjamin; Fort, Pierre-Arnaud; Vicenzi, Oriane; Ruche, Valérie; Millet, Anthony; Chouihed, Tahar; Baugnon, Daniel; Daniel, Nathalie; Boulanger, Bertrand; Galant, Julien; Le Hot, Henri; Rothmann, Christophe; Guenot, Isabelle; Cochonneau, Mathieu; Smaiti, Nadia; Lachery, Patricia; Wiel, Eric; Thiriez, Sylvain; Abdelli, Lila; Kasdali, Rachid; Ramaherison, Thierry; Guidez, Thomas; Bailly, Charles; Poher, Fabien; Idrissi, Annick; Humbert, Karine; Andregnette, Paul; Pic, Daniel; Dublanchet, Nicolas; Giroud, Géraldine; N'Guyen, Guillaume; Jainsky, Laure; Lacrouts, Marc; Liepa, Marie-Pierre; Esturoune, Gaëlle; Ximenes, Arnaud; Randrianasolo, Ialasoa; Mathe, Mélanie; Chable, Hélène; Le Cardinal, Géraldine; Zix-Minni, Anne-Marie; Le Borgne, Pierrick; Schweitzer, Fanny; Ben Hammouda, Kasarra; Schmitt, Jacques; Compte, Gaëlle; Delaroche, Marine; Di Filippo, Christian; Potinet, Véronique; Regal, Olivier; Nahani, Alireza; Faivre, Jacques; Sturiale, Teddy; Touil, Mohammed; Di Rollo, Mario; Laine, Olivier; Gerain, Mathieu; Latappy, Marc; Ageron, François-Xavier; Vallenet, Claire; Leleu, Agathe; Blandin, Morgan; Paquet, Anne-Laure; Fievet-Brochot, Marie-Laurence; Hansconrad, Erwin; Vivien, Benoît; Principe, Alessandra; Thiebaud, Pierre-Clément; Trabattoni, Eloïse; Burggraff, Eric; Boust, Emmanuel; Massol, Valérie; Benet, Xavier; Foubert, Quentin; Jardel, Benoît; Roussel, Mélanie; Joly, Luc-Marie; Ovtcharenko, Mariane; Bedrici, Karim; Abdeljaouad, Mohamed; Mauger-Briche, Carole; Berton, Laurence; Dalle, Ludovic; Violeau, Mathieu; Amizet, Loïc; Fontaine, Fanny; Colonna, Anaïs; Tida, Jean; Cwicklinski, Emelyne; Fradin, Philippe; Vallejo, Christine; Frigui, Lotfi; Bregigeon, Samia; Porche, Muriel; Le Jan, Arnaud; Desclefs, Jean-Philippe; Andrianjafy, Hery; Wajzer, Laura; Hung, Ta Trung; Beaune, Sébastien; Lenglet, Hugo; Le Bail, Gaëlle; Bouchara, Anna; Kouka, Marie-Clément; Wargon, Mathias; David, Steven; Khalid, Mohamed; Phlippoteau, Catherine; Diez, Stéphane; Sende, Jean; Baermann, Xavier; Legall, Catherine; Fehre, Aurélie; Etiennar, Célia; Roudiak, Nathalie; Talfournier, Julie; Lefebvre, Chloé; Claessens, Yann-Erick; Carron, Pierre-Nicolas; Dami, Fabrice; Popotte, Esther; Belkouch, Ahmed; Pujo, Jean-Marc
Source
BMC Geriatrics. September 21, 2020, Vol. 20 Issue 1
Subject
Language
English
ISSN
1471-2318
Abstract
Author(s): Anne-Laure Feral-Pierssens[sup.1,2,3], Gustave Toury[sup.1], Fatima Sehimi[sup.4], Nicolas Peschanski[sup.5], Saïd Laribi[sup.6,7], Amélie Carpentier[sup.8], Magali Kraif[sup.9], Clément Carbonnier[sup.10,11], François-Xavier Duchateau[sup.12], Yonathan Freund[sup.2,13,14], Philippe Juvin[sup.1,2,15], Patrice Serre[sup.16], Aurélie Arnaud, Edouard Dugat, Céline [...]
Background For 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. Methods A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged [greater than or equai to]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. Results One 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]). Conclusion Professional 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 registration Clinicaltrial.gov - NCT02900391, 09/14/2016, retrospectively registered Keywords: Elderly , Healthcare access , Loss of autonomy , Home services , Emergency care
Background For 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. Methods A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged [greater than or equai to]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. Results One 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]). Conclusion Professional 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 registration Clinicaltrial.gov - NCT02900391, 09/14/2016, retrospectively registered Keywords: Elderly , Healthcare access , Loss of autonomy , Home services , Emergency care