Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long-term trends

Background: Exacerbations requiring hospital admission for chronic obstructive pulmonary disease (COPD) contribute to a decline in health status and are costly to the community. Long‐term trends in admissions and associated outcomes are difficult to establish because of frequent readmissions, high case fatality and potential diagnostic transfer between COPD and asthma. The Western Australian Data Linkage System provides a unique opportunity to examine admissions for patients with COPD over the long term. Method: Nineteen years of hospital morbidity data, based on International Classification of Diseases‐9 criteria were extracted from the Western Australian Data Linkage System (1980–1998) and merged with mortality records to examine trends in hospital admissions for COPD. Results: The rate of hospital admissions for COPD has declined overall and the rate of first presentation declined in men and remained constant in women. The risk of readmission increased throughout the period (P < 0.0001) and more than half of all admissions were followed by readmission within a year. Median survival following first admission was 6 years (men 5 years; women 8 years). Age, sex and International Classification of Diseases subcategory each showed an independent effect on the risk of mortality (P < 0.0001). The poorest survival was in patients subcategorized as emphysema. For patients with multiple admissions, the likelihood of cross‐over between COPD and asthma was high and increased with the total number of admissions. Conclusion: The rate of admission for COPD has declined in Western Australia; however, the resource burden will continue to increase because of the ageing population. This has policy implications for the development of acute care treatment programmes for COPD.     

Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome

Background: Despite the publication of several management guidelines for exacerbations of chronic obstructive pulmonary disease (COPD), there is little information on standards of care in clinical practice. The aim of this audit was to examine the assessment, management and outcome of COPD admissions to a secondary and tertiary referring New Zealand hospital during two different seasons. Compliance to current recommendations was examined and compared with the available international published work. Methods: All COPD‐related admissions to Waikato Hospital during the months of May and October 2004 were reviewed. Ninety‐four cases (from 84 patients) were audited. Results: General characteristics, clinical features and lung function tests were similar to that of other cohorts. Twenty‐three per cent of the admissions were Maori and the mean age of Maori admissions were significantly less than that of the non‐Maori admissions (57 and 72 years, respectively; P = 0.0001). The geometric mean length of stay was 3.4 days, which is significantly less than most other reported hospital lengths of stays related to exacerbations of COPD. Fifty‐five per cent of the cohort was admitted more than once to the hospital for COPD in the 12 months before the index admission. Thirteen per cent of all admissions received assisted ventilation. Overall 30‐day mortality was 8% and the 12‐month mortality was 31%. Decreased body mass index was a risk factor for death as was an increased CURB‐65 (confusion, urea, respiratory rate, blood pressure age) score – a simple bedside assessment score, which has previously been used to predict mortality in patients with community‐acquired pneumonia. Conclusion: This audit documented the general characteristics, assessment, management and outcome of the COPD admissions to a secondary New Zealand hospital. Further investigations into factors contributing to shorter length of stay and predictors of mortality are needed.     

Admission for COPD Exacerbation Is Associated with the Clinical Diagnosis of Pulmonary Hypertension: Results from a Retrospective Longitudinal Study of a Veteran Population

Patients with chronic obstructive pulmonary disease and pulmonary hypertension (PH–COPD) have an increased risk of hospitalizations and death compared to COPD alone. Identifying PH in COPD is challenging because performing right heart catheterization, the gold standard for PH diagnosis, is invasive and not routinely performed. Clinical characterization of COPD patients at risk who are progressing toward PH will aid therapeutic development at earlier stages of progressively fatal PH–COPD. We studied the records of 5,45,086 patients in a large Veterans Affairs healthcare network (2000–2012) with a primary discharge diagnosis of COPD based on encounters' ICD-9 codes and further stratified into those who received an additional ICD-9 code for a PH diagnosis. Patients with PH–COPD were assigned to one of the four subgroups: those with (a) no history of exacerbation or hospital admissions, (b) history of exacerbations but no hospital admissions, (c) hospital admissions unrelated to COPD and (d) history of COPD exacerbation-related hospital admissions. We also examined the COPD and COPD-PH cohorts for associated comorbidities such as cardiac disease and the presence of obstructive sleep apnea (OSA). A regression analysis revealed that patients with COPD exacerbation-related hospital admissions had 7 × higher risk of having a concomitant clinical diagnosis of PH compared to non-hospitalized patients. COPD-PH patients had higher rates of cardiac comorbidities (89% vs. 66%) and OSA (34% vs. 16%) compared to COPD alone. We conclude that COPD patients hospitalized for COPD exacerbations are at a higher risk for developing PH, and hospitalized COPD patients with cardiac comorbidities and/or OSA should be screened as at-risk population for developing PH.     

Predictors of nursing home admission for older adults hospitalized with heart failure

The objective of this retrospective chart review study was to determine the prevalence and predictors of nursing home admission of older hospitalized heart failure patients. Subjects were Medicare beneficiaries discharged with a principal diagnosis of heart failure in 1994 in the state of Alabama, United States. The outcome variable was admission to a nursing home after hospital discharge. Using multivariable logistic regression analyses we determined patient and care variables independently associated with admission to a nursing home. Patients (n = 985) had a mean (+/- S.D.) age of 79 (+/- 7.5) years, 61% were female and 18% African-American. Eighty-three (8%) patients were admitted to a nursing home. Over 80% of those admitted to a nursing home had prior nursing home residence. After adjustment for various demographic, clinical and care variables, age (adjusted odds ratio [OR] = 1.14; 95% confidence interval [95%CI] = 1.06-1.23), pre-admission residence in a nursing home (adjusted OR = 1422; 95%CI = 341-5923), and length of hospital stay (adjusted OR = 1.11; 95%CI = 1.02-1.20) were independently associated with admission to a nursing home. Among patients with no prior nursing home residency (n = 908), 15 (2%) patients were newly admitted to a nursing home upon discharge. In addition to age and length of stay, diabetes (adjusted OR = 6.46; 95%CI = 1.58-26.41) was independently associated with new admission to a nursing home. In conclusion, nursing home admission rate for this cohort of older hospitalized heart failure patients was low. Age, length of hospital stay, and diabetes were associated with new nursing home admissions. Further studies are needed to identify modifiable risk factors for nursing home admissions and to develop appropriate interventions.     

Cost of Chronic Obstructive Pulmonary Disease in the Emergency Department and Hospital

Study objectives: Treatment of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) or hospital accounts for a significant portion of COPD costs. This study estimates the cost of a COPD ED or hospitalization visit in the US. Design: This observational study utilized administrative data from 218 acute care hospitals. ED/hospital discharges for COPD (International Classification of Diseases — Ninth Revision — Clinical Modification codes 491.xx. 492.xx, 496.xx) during 2001 were identified. Costs were determined for three groups: (i) ED only; (ii) standard admission; and (iii) severe admissions (intensive care unit [ICU] or intubation). Severe admissions were stratified into: (i) ICU/no intubation; (ii) intubation/no ICU; and (iii) ICU + intubation. Mean total costs and length of stay (LOS) were calculated for each group. Results: A total of 59 735 ED/hospital encounters were identified: 20 431 ED only, 33 210 standard admissions, and 6094 severe admissions (4456 ICU/no intubation, 496 intubation/no ICU, and 1142 ICU/intubation). ED visits had a mean cost of $US571 ± 507 (year 2001 value). Inpatient costs ranged from $US5997 (± 5752) for a standard admission to $US36 743 (± 62 886) for ICU plus intubation admissions, while LOS ranged from 5.1 days (±4.5) to 14.8 days (± 16.7), respectively. In addition, only 10% of encounters required an intubation/ICU admission, but these accounted for 34% of the cost. Conclusion: Cost of a COPD hospitalization is substantial in the US, with one-third of those costs being associated with severe admissions, which make up only 10% of all COPD admissions. Treatments aimed at reducing hospitalizations and length of stay could result in substantial cost savings.     

Factors associated with a protracted hospital stay after hip fracture surgery in Japan

Aim: Hip fracture is a major injury in the elderly and has a high impact on quality of life and use of health‐care resources. In this study, we aimed to identify the factors related to prolonged hospital stay and poor outcome after hip fracture surgery. Methods: We evaluated data from 8920 cases at 398 acute‐care hospitals in Japan. Multivariate logistic regression analysis was used to determine the factors associated with the length of postoperative hospital stay. Results: A shorter postoperative hospital stay was associated with admission to a high surgical volume hospital (P < 0.001). On the other hand, a longer postoperative hospital stay was associated with infective complications, admission to a private hospital, an interval of more than 3 days between admission and surgery (P < 0.001 for all), and an interval of more than 1 day between surgery and start of rehabilitation (P = 0.01). Further analysis revealed that infective complications were more likely in older patients (P = 0.003) and patients with comorbidities (P = 0.03). Conclusion: The results imply that hospital stay, and, therefore, use of medical resources, can be decreased by performing surgeries shortly after patients are admitted, preventing postoperative infections, and starting rehabilitation on the next day of the surgery. One of the limitations of our study was that data of the length of hospital stay at transferred hospitals were not available. Therefore, further prospective studies will be needed to address significance of early surgery and rehabilitation. Geriatr Gerontol Int 2011; 11: 474–481.     

Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract. de la Iglesia F, Valiño P, Pita S, Ramos V, Pellicer C, Nicolás R, Diz‐Lois F (Juan Canalejo Hospital, A Coruña, Spain). Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease. J Intern Med 2002; 251: 500–507. Objective. To investigate the factors predicting a hospital stay of over 3 days in patients who required hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). Design and setting. A cross‐sectional tudy was done at a tertiary hospital serving an area of 500 000 inhabitants. Subjects. A total of 273 patients (α=0.05; accuracy=5.94%) who had been admitted consecutively to the Short Stay Medical Unit at the Juan Canalejo Hospital in A Coruña, from February 1998 to March 1999, with a diagnosis focusing on exacerbation of COPD. Methods. Demographic variables, past medical history, symptoms, arterial blood gases, functional tests, treatment and the cause of exacerbation were studied in each patient. The hospital stay was dichotomized into ≤3 vs. >3 days. The prognostic factors of a hospital stay were determined by log regression. Results. The mean stay was 4.6 ± 5.1 days (range: 1–64). After monitoring the associated covariables, the following were found to have an independent effect on the prediction of a hospital stay of over 3 days: weekend admissions (OR=4.17; 95% CI: 2.42–7.18), the presence of cor pulmonale (OR=2.19; 95% CI: 1.27–3.78), and the respiratory rate on admission (OR=1.09; 95% CI: 1.03–1.14). Arterial blood gases and functional tests showed no independent effect. Conclusions. The factors having an independent prognostic value in determining the length of hospital stays in patients with COPD are weekend admission, cor pulmonale and respiratory rate. Additional studies are required to validate these findings.     

Socioeconomic circumstances and incidence of chronic obstructive pulmonary disease (COPD) in an urban population in Sweden

The association between socioeconomic circumstances and incidence of chronic obstructive pulmonary disease (COPD) was investigated in an urban population in Sweden. The study included all 40–89 year-old inhabitants in Malmö, Sweden (N?=?117,479) without previous hospitalization due to COPD, who were followed over 14 years for COPD related hospital admissions. The Malmö Preventive Project (MPP) cohort (n?=?27,358) with information on biological and lifestyle factors was also used to study the association between socioeconomic circumstances and COPD. The Swedish hospital discharge register was used to record incidence of COPD hospitalizations. A total of 2,877 individuals (47.5% men) were discharged from hospital with COPD as the primary diagnosis during follow-up in Malmö. Low annual income (hazard ratio (HR): 2.23; 95%CI: 1.97–2.53, P?P?P?P?1, BMI, age and sex. However, socioeconomic circumstances were not associated with COPD in analyses restricted to never smokers. Low socioeconomic circumstances were associated with an increased risk of COPD after adjustments for biological and lifestyle risk factors including smoking status. However, this relationship was not significant in those who never smoked.     

Population Decline in COPD Admissions During the COVID-19 Pandemic Associated with Lower Burden of Community Respiratory Viral Infections

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of severe acute respiratory syndrome coronavirus 2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of chronic obstructive pulmonary disease (COPD) exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown.MethodsWe performed retrospective analysis of data from a large, multicenter health care system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences analysis to compare season-matched weekly frequency of hospital admissions for COPD prior to and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Centers for Disease Control and Prevention test positivity data and correlated to COPD admissions.ResultsData involving 4422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during the COVID-19 pandemic, which correlated to community viral burden (r = 0.73; 95% confidence interval, 0.67-0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (incidence rate ratio 0.64; 95% confidence interval, 0.57-0.71, P < .001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions.ConclusionThe implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.     

Does early pulmonary rehabilitation reduce acute health‐care utilization in COPD patients admitted with an exacerbation? A randomized controlled study

Background and objective: In COPD, hospital admissions and readmissions account for the majority of health‐care costs. The aim of this prospective randomized controlled study was to determine if early pulmonary rehabilitation, commenced as an inpatient and continued after discharge, reduced acute health‐care utilization. Methods: Consecutive COPD patients (n = 397), admitted with an exacerbation, were screened: 228 satisfied the eligibility criteria, of whom 97 consented to randomization to rehabilitation or usual care. Both intention‐to‐treat and per‐protocol analyses are reported with adherence being defined a priori as participation in at least 75% of rehabilitation sessions. Results: The participants were elderly with severe impairment of pulmonary function, poor health‐related quality of life and high COPD‐related morbidity. The rehabilitation group demonstrated a 23% (95% CI: 11–36%) risk of readmission at 3 months, with attendees having a 16% (95% CI: 0–32%) risk compared with 32% (95% CI: 19–45%) for usual care. These differences were not significant. There were a total of 79 COPD‐related readmission days (1.7 per patient, 95% CI: 0.6–2.7, P = 0.19) in the rehabilitation group, compared with 25 (1.3 per patient, 95% CI: 0–3.1, P = 0.17) for the attendees and 209 (4.2 per patient, 95% CI: 1.7–6.7) for usual care. The BMI, airflow obstruction, dyspnoea and exercise capacity index showed a non‐significant trend to greater improvement among attendees compared with those receiving usual care (5.5 (2.3) and 5.6 (2.7) at baseline, improving to 3.7 (1.9) and 4.5 (2.5), respectively, at 3 months). No adverse effects were identified. Conclusions: Early inpatient–outpatient rehabilitation for COPD patients admitted with an exacerbation was feasible and safe, and was associated with a non‐significant trend towards reduced acute health‐care utilization.     

Social factors influencing hospital utilisation by tuberculosis patients in the Russian Federation: analysis of routinely collected data.

OBJECTIVE: To establish whether admissions, discharges and hospital utilisation for tuberculosis (TB) in Russia are independent of sex, age, disability and employment status. STUDY POPULATION AND METHODS: Analysis of hospital admissions, discharges and in-patient utilisation using routinely collected data in Samara Region of the Russian Federation. RESULTS: Male, unemployed and disabled adults were significantly more likely to be hospitalised (P < 0.001). The unemployed and pensioners were more likely to have multiple admissions. Unemployed adults were more likely to have longer average lengths of stay per admission (P < 0.001), with a cumulative length of stay for unemployed and disabled adults significantly greater than for employed adults and adults with no disability. Interruption of hospital care was significantly more frequent in male, disabled and unemployed patients (P < 0.001). CONCLUSIONS: Socio-economic factors influence hospital admission patterns and the length of stay for patients when hospitalised, as the providers of TB services attempt to mitigate the lack of social care provision for patients. For the WHO DOTS strategy to be effectively implemented and sustained in the Russian Federation health system, social sector linkage issues need to be addressed.     

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity,infection and chronic heart failure

Background: In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65–74‐year‐old age group, COPD was the sixth leading cause of disability for men and the seventh for women. Aims: To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD. Methods: Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001–2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity‐based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs. Results: Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006). Conclusion: This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.     

Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease

OBJECTIVES: The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life. METHODOLOGY: Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case-managed group. RESULTS: In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case-managed patients had a significant improvement in their quality-of-life scores. CONCLUSIONS: In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.     

Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease

Background and objective: Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1‐year integrated care (IC) programme comprising two components (patient‐centred education + case management) would be effective in preventing COPD‐related hospitalizations. Methods: This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty‐nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient ‐centred education—involving three group sessions of self‐management education that included one motivational interview and instruction in the use of a written action plan; and case management—involving scheduled follow‐up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD‐related re‐hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes. Results: Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re‐hospitalization over the follow‐up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23–0.85). Subgroup analyses revealed that the IC programme prevented more COPD‐related hospitalizations in women compared with men. There were no significant between‐group differences in length of hospital stay or number of ED visits. Conclusions: An IC programme combining self‐management education and case‐management can decrease rates of COPD‐related hospitalizations, particularly among women.     

A Note on the Interface Between a Residential Alcoholism Rehabilitation Centre and Detoxication Centres

Details of admissions to Southern Ontario Detoxication Centres were obtained for a sample of 50 skid-row alcoholics admitted to a rural residential rehabilitation programme (Bon Accord Farm). In the year prior to admission to Bon Accord the men averaged 3.7 detox admissions, while in the year after leaving this average increased to 7.2 admissions. Rates of detox admission after leaving and changes in these rates from the previous year were unrelated to length of stay. It is suggested that Bon Accord should be seen as one of a range of social agencies that made up the social world of public inebriates and that such agencies should be principally valued for their humanitarian and care giving functions. An improved co-ordination of skid-row agencies is suggested as is a more careful assessment of candidates for rehabilitation programmes.     

A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease

BACKGROUND: A steady increase in chronic obstructive pulmonary disease (COPD) admissions was addressed by enhancing primary care to provide intensive chronic disease management. AIM: To compare the effect of a disease management programme, including a COPD management guideline, a patient-specific care plan and collaboration between patients, general practitioners, practice nurses, hospital physicians and nurse specialists with conventional care, on hospital admissions and quality of life. METHODS: One hundred and thirty-five patients with a clinical diagnosis of moderate to severe COPD were identified from hospital admission data and general practice records. General practices were randomized to either conventional care (CON), or the intervention (INT). Pre- and post-study assessment included spirometry, Shuttle Walk Test, Short Form-36, and the Chronic Respiratory Questionnaire (CRQ). Admission data were compared for 12 months prior to and during the trial. RESULTS: For respiratory conditions, mean hospital bed days per patient per year for the INT group were reduced from 2.8 to 1.1, whereas those for the CON group increased from 3.5 to 4.0 (group difference, P = 0.030) The INT group also showed an improvement for two dimensions of the CRQ, fatigue (P = 0.010) and mastery (P = 0.007). CONCLUSIONS: A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers.     

Anxiety and depression—Important psychological comorbidities of COPD

Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). The pathophysiology of these psychological comorbidities in COPD is complex and possibly explained by common risk factors, response to symptomatology and biochemical alterations. The presence of anxiety and/or depression in COPD patients is associated with increased mortality, exacerbation rates, length of hospital stay, and decreased quality of life and functional status. There is currently no consensus on the most appropriate approach to screening for anxiety and depression in COPD. Treatment options include psychological [relaxation, cognitive behavioural therapy (CBT), self-management] and pharmacological interventions. Although there is some evidence to support these treatments in COPD, the data are limited and mainly comprised by small studies. Pulmonary rehabilitation improves anxiety and depression, and conversely these conditions impact rehabilitation completion rates. Additional high quality studies are urgently required to optimise screening and effective treatment of anxiety and depression in patients with COPD, to enhance complex chronic disease management for these patients.     

Cost‐Effectiveness of a Barcelona Home Care Program for Individuals with Multimorbidity

To improve the efficiency and effectiveness of care and optimize healthcare resources, a home healthcare program was created for individuals with multiple chronic conditions. Demographic and clinical characteristics of the 261 individuals (mean age 84) included in the program from its inception in 2011 through 2013 (mean stay in the program 203 ± 192 days) were prospectively analyzed. The number of hospital admissions, length of stay, and costs for individuals admitted to the program were compared for two time periods: the 6 months before admission to the program and their stay in the program. After admission to the program, the number of hospital admissions and the hospital length of stay per person per month decreased from 0.36 ± 0.21 to 0.19 ± 0.52 (P < .001) and from 3.5 to 1 day (P < .001), respectively. Surveys of randomly selected patients and caregivers showed high satisfaction with the program. Costs per person per day decreased from €54.65 (US$73.12) to €17.91 (US$23.96), a reduction of 67.1%. Fewer admissions and shorter hospital stays enabled the hospital to eliminate five acute beds for every 50 individuals admitted to the program. In conclusion, home care for individuals with chronic illness with multimorbidity reduced the number of hospital admissions and length of stay, resulting in good patient satisfaction and lower costs.