The home also as a place of care, not to replace the hospital, but to optimize time and resources, meeting the needs of patients where possible. This was the spirit behind the project of the Hematology Department of the Umberto I General Hospital in Rome and the Rome section of the Italian Association against Leukemia, Lymphoma and Myeloma (AIL) on continuity of care for hematological patients. In two years, in the midst of the Covid era, the project followed 243 patients, who were placed in a program of integrated and simultaneous hospital-home care.
The idea behind the initiative – coordinated by Claudio Cartoni, Head of the Palliative and Home Care Unit (UCPD) and by Maurizio Martelli, director of the UOC of Hematology – was to guarantee the continuity of care and at the same time the quality of life of the patients. “Therapeutic continuity is very different from the home care we are used to – commented Martelli – it is a real care activity outside the hospital structure. We experienced it in an emergency phase: in the toughest period of the pandemic we effectively treated about two hundred patients at home, patients who could not have reached the hospital or who would have run too high a risk of contagion. We have shown that it can be done.”
But the project, born in an emergency phase, is a candidate to revolutionize the way of understanding therapies, as well as home care. And not just by promoting a more appropriate use of hospital beds. “The territorial continuity approach between hospital and home is revolutionizing the holistic approach to care – added Cartoni – medical therapies leave hospitals, guaranteeing equality of care for those who have difficulty accessing them, guaranteeing medical, social and psychological to the most fragile patients. Numerous studies show that social isolation is an important variable in the course of the disease, which is why this approach has great value from a therapeutic point of view. The good practice of Umberto I is made possible by the synergy between the health facility, AIL Rome and the Lazio Region”. And it could now become a skill to be trained in the new generations of doctors, concluded Alberto Deales, medical director of the Umberto I polyclinic, to increasingly bring medicine to the service of patients, even outside hospitals.
The promises of continuity of care are also combined with data relating to savings for health systems from the dislocation of care outside the hospital. Some data in this regard comes from a study published recently on the savings associated with the administration of early palliative care compared to standard hospital care for frail patients, which involved 119 patients. Those cared for at home (59) were more debilitated and had a shorter survival than the 60 in the hospital group (2.7 versus 8.4 months, but the proportion of terminally ill patients was higher in those at home, 41% versus 28%). The symptoms however were similar in both groups, at home the average weekly number of transfusions (1.45) was lower than that in the hospital (2.77), as was that of infections (21% against 54%). Finally, the average weekly cost of care for ordinary hospitalization was significantly higher in a 3:1 ratio compared to home care which would have saved about 2300 euros for the health system, according to the authors, and added about 90 euros in more on family expenses.