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AIXIAL Review #3

Hospitalization at home (HAH), an indispensable source of real-life data

 

Hospitalization at home (HAH) is now a well established mode of care in France as in many other countries.

Although not all pathologies and patients can benefit, be it for medical or equipment-related reasons, HAH now covers a vast area of ​​diseases and is part of the care pathway for many patients. Consequently it is now possible to transfer care from a hospital to an ambulatory setting for an increasing number of cases each year. It has also rendered possible care within the home that would previously have been difficult to manage, deliver and coordinate.

Thanks to the quality of care and coordination provided, one can expect from this mode of « extramural » hospitalization, better medical results, a decrease in the risk of nosocomial infections and an improvement in patient comfort and quality of life[1].

But such a change in the way care is provided, HAH, the cornerstone of what is often called an “ambulatory shift”, would not be possible without major organizational and cultural change. Having become an indispensable source of real-life data, the RWE researcher must also adapt. Indeed, places where the data is collected, interlocutors, data sources, information systems have changed with the shift to ambulatory care. So it is necessary to build new research processes.

To obtain RWDs from HAH, we can certainly use the specific bases of the PMSI[2]-HAH (HAD in French) and analyze them to characterize and identify the management methods according to the patients and the pathologies, as HAS has been able to do for cancer chemotherapy[3]. However, the medico-administrative databases of the Health Insurance do not allow the use of all the medical and medico-social data collected or likely to be collected during a HAH stay. Specifically, it has become essential to integrate the voice of the patient and his entourage in the additional data to be collected because they are in essence core to care and the most involved in the monitoring of HAH interventions.

To make the data from the HAH usable, one of the first challenges for researchers is to structure them in the form of a database, the purpose of which could eventually be to join the databases of the Health Data Hub[4].

The “Santé Service” public utility foundation is the largest HAH structure in France with nearly 1,800 patients treated every day throughout the “Ile-de-France” region. In addition to the home hospitalization of patients suffering from various pathologies[5] (oncology, complex wounds, orthopedic surgery, obstetric care, neonatology, cardiac and respiratory diseases, neurological or behavioral disorders, etc.), the Foundation “Santé Service” provides residents with home nursing services (SSIAD[6]), specialized Alzheimer’s teams (ESA[7]) as well as a service dedicated to long-term support for people in complex situations (MAIA[8]).

In order to generate useful knowledge, “Santé Service” and CRO[9] AIXIAL are joining forces to build a scientifically usable database and to jointly conduct clinical and epidemiological studies of public health interest. These studies will make it possible in particular to measure the use of medical products, quality of life, patient satisfaction and the impact of drugs / medical devices on the population’s health, as well as the budgetary impact of outpatient healthcare in pathologies taken care of by “Santé Service” during the HAH.

In this context and with the help of methodologists, health assessors and patient representatives, AIXIAL is opening a consultation for the benefit of industrials who develop and market drugs or medical devices in order to build with them and Health Service the best studies to answer their needs and those of the health authorities and then achieve them thanks to the operational teams of AIXIAL.

— Written by Jacques Massol, MD PhD, prof of Therapeutics, AIXIAL consultant

and Marc Poterre, MD, Head of Research and Innovation – Fondation Santé Service 

[1] Knowing the risk of desocialization, induction of dependence or even slippage syndrome (syndromes de glissement) to which prolonged hospital stays expose, especially in elderly, fragile             subjects, we can only rejoice in this offer of home care which is carried out in a soothing familiar surroundings and if possible in an attentive family context.

[2] Programme de médicalisation des systèmes d’information

[3] https://doi.org/10.1016/j.respe.2015.01.050

[4] Health data hub | Plateforme Des Données De Santé | France www.health-data-hub.fr

[5] The expected figures for 2020 include: Estimation of the number of patients in 2020 treated for:

Cancer 5701
Dermatology (wounds ++) 1049
orthopedy (coxarthrosis ; gonarthrosis) 987
Obsterics 1785
Post-partum 2324
Néonatology 1267
Cardio-respiratory diseases 597
Neurology and behavioral troubles 713
Others 1324

[6] services de soins infirmiers à domicile (SSIAD)

[7] équipe Spécialisée pour les malades Alzheimer (ESA)

[8] Méthode d’Action pour l’Intégration des services d’aides et de soins dans le champ de l’Autonomie (MAIA)

[9] Contract Research Organization (CRO)

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