La continuidad de cuidados desde el hospital de agudos: resultados

Abstract

ResultsAbstractObjective: To describe the profile of patients treated by a Continuity of Care Manager in anacute-care center during the first six months of its activity, as well as the profile of patientstreated and the resource allocation.Method: A prospective cross-sectional study was conducted on patients with complex careneeds requiring continuity of care liaison, and who were attended by the Continuity of CareNurse during the period from October 2013 to March 2014. Patient characteristics, their socialenvironment and healthcare resource allocation were registered and analyzed.Results: A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age80.57 ± 10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multiva-riate model, it was observed that the variables associated with readmission were polypharmacy(OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88).Conclusions: Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidi-ties, geriatric syndromes, complex care, and of life needs, to whom an alternative solution tohospitalization is provided, thus preventing readmissions.