IPCHS. Integrated People-Centred Health Services


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Nov. 26, 2020 Europe, Global

Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department

Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization.

The growing burden of chronic diseases, patients experiencing fragmented care, and increasing demand for coordination across providers in the health and social sector correlates with the need for the integration of care. The starting point in developing an integrated care strategy should be identifying and assessing population needs.

Models of integrated care may enhance patient satisfaction, increase the perceived quality of care, and enable access to services. The term ‘new models of care’ refers to a wide range of interventions aiming to address issues of integration across healthcare and between health and social care. Improved discharge planning and flow of care, and improved sharing of knowledge between practitioners, are essential components of new models of integrated care. Discharge of the patient from the hospital to the community is critical in patient care, especially for patients with multiple comorbidities, elderly patients, or those with impaired function. Inappropriate discharge destination and incomplete communication with patients and ambulatory care can lead to adverse outcomes (e.g., emergency department visits and adverse events).

This research aimed to determine and compare: (1) the level of unmet needs in a group of emergency department patients and a group of general practice patients; (2) factors determining the level of unmet needs as elements of an integrated model of community care for a patient discharged from the emergency department; and (3) the chances of hospitalization in both groups depending on the level of satisfaction of the need.


International Journal of Integrated Care