Home Hospitalization Program: Rationale, Organization and Outcome / תכנית אשפוז בית: רעיון, ארגון ותוצאות

The Jerusalem home hospitalization (HH) program was initiated by the community institute of geriatric medicine of the Clalit Sick Fund in November 1991. The program had the primary aim of shortening or preventing hospitalizations. Patients entered the program either from hospitals, facilitating early discharge, of from the community to obviate the need to hospitalize. Senior physicians of the HH program made regular hospital ward rounds and home visits were made at the treating family physician's behest to determine patient suitability. The criteria for entrance to the HH program included full accord of the patient and family, membership in the Clalit Sick Fund, residence in Jerusalem, a medical condition which would otherwise require hospitalization, and a home support network adequate to ensure basic living needs. Patients generally comprised three categories: medical, palliative (terminal patients) and rehabilitation. Patients admitted to the HH program were admitted within 24 hours of referral or hospital discharge by the treating physician. The treating physician made home visits as required with a minimum requirement of six visits nonthly. Often a nurse also participated in HH care making visits from a minimum of twelve monthly to as often as twice daily. Both the treating physician and nurse were constantly available for telephone consultation and emergency visits. Additional services which could be rendered as needed included physiotherapy, occupational therapy, electrocardiogram, drawing blood or collecting urine for analysis or culture, consulting physicians in eleven disciplines and the intervention of a social worker. A single patient file remained in the patient's home and documented all data and treatment. Once a month a supervising senior physician visited the patients jointly with the treating physician. From November 1991 through the end of 1994 1596 patients (695 male, 901 femake) entered the HH program. Their average age was 75 (range 13-95). These patients received a total of over 90,000 days' care by 88 individual physicians. The average duration of HH care was 56 days. 20% of HH patients died during their care (53% of them were terminal oncology patients). Of the surviving patients 62% returned to the care of their family physicians, 17% continues in a scaled-down hospitalization prevention program using HH physicians, 1% left the Jerusalem area and could not continue HH care and only 19% were hospitalized (17% acute care, 2% nursing