Patients' Experiences in a Medicalized Hotel for COVID-19 Acute Care Support

The 11th March 2020, the World Health Organization (WHO) declared the novel coronavirus Covid-19 as a pandemic. Urgent reorganization was required to give answers to the needs of this new illness. Since mid March, the number of patients admitted every day grew exponentially, and despite strengthening the Home Hospitalization service, resources were insufficient to care for such a number of people at home. The HH was called to transform a hotel into a medicalized healthcare space.

Current health policy emphasizes on patient experience, as one of the key components of quality of care. Analyzing patients experience will provide knowledge about their authentic concerns or what they identify as real needs, how they perceive the care received and will allow finding out if it was a good alternative. Patients must be involved in decision-making about their heath situation and treatment in order to provide an integrated healthcare.

Aims: To assess the patient experience during hospital admission in a Medicalized Hotel for COVID-19, from 8th March to 25th May, and variables that may influence these experiences.

Study type: Observational and descriptive study with a cross-sectional design. The study population consisted of patients admitted in Medicalized Hotel who met inclusion criteria.

Sample size: 517 patients. Main variable: Patient experience (collected by the Picker Patient Experience questionnaire, PPE-15, translated to Catalan and Spanish), that content four open questions analyzed in a qualitative way. Other variables: Socio-demographic and review clinical records.

Study Overview

• Status: Completed
• Conditions: COVID-19; Patient Preference

Detailed Description

The current pandemic caused by the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) demands urgent reorganization. Hospital multidisciplinary and departmental collaboration was required to work on all the principles of overvoltage capacity, including: new space definition; provision's resources; staff recruitment; and ad hoc training. Likewise, assistant protocols suffered continuous modifications to deal with this new situation.

Catalonia is one of the 17 autonomous communities of Spain and it has been granted global competencies in the area of healthcare. The Catalan healthcare model is a multi-provider one integrated in a unique public network. The organization is structured in four integrated health areas, one of which is the Integrated Health Area of Barcelona Esquerra (Área Integral de Salud de Barcelona Esquerra - AIS-BE), caring for a population of 524,000 inhabitants, representing 35% of the population of Barcelona. The territory referred to this study, includes the Hospital Clinic as reference center, two general hospitals and 19 primary care centers. The Hospital Clínic -a tertiary university hospital- is a public institution with a long reputation of excellence in care provision, training and research at national and international level.

The management of the Hospital Clinic worked on a contingency plan, at internal and territorial level, together with the Health Department of the Generalitat de Catalunya. For the internal contingency plan to deal with the pandemic, different committees were created. Two of them were the Technical /Operational Committee and the ICU Committee. The technical committee included the Departments of Internal Medicine, Infections, Pneumology, Microbiology and all the medical and surgical departments with ICUs, occupational health, and the transversal Home Hospitalization Unit (HH) to maximize cooperation among professionals, levels of care and institutions. Hospital-at-home is defined as the service in charge of providing active treatment by health care professionals, in patient's house, for a condition that otherwise would require traditional hospitalization for a limited period of time (8). Hospital-at-home is a safe and cost effectiveness service, and has become a popular response to the increasing demand for acute hospital beds.

The idea of transforming a hotel into a healthcare facility wanted to solve three needs: a) grouping patients who required HH, b) providing more beds (offering intermediate care to patients who didn't require critical care) and c) allowing the isolation of people who cannot do it at home.

This paper consists in an observational and descriptive study with a cross-sectional design, in which we analyze patients' experience during admission in a Medicalized Hotel using a validate survey.

The study population consisted of patients admitted in Medicalized Hotel led by Hospital Clinic, Barcelona from 25th March to 8th May.

Inclusion criteria: All patients admitted in Medicalized Hospital who agreed to participate in the study Exclusion criteria: non localized or localized but rejected to participate, language barrier and dementia.

Data collection: The Picker Patient Experience Questionnaire validated into Spanish was used to measure the patient experience. The PPE-15 was developed to elicit feedback from patients to highlight aspects of care that needed improvement and to monitor performance and care.

Participants included in this analysis responded voluntarily to an online questionnaire distributed by mail, focused on their experiences around Medicalized Hotel admissions and transitional care strategies after 1 month of discharge. The questionnaire was carried out by telephone to the patients who did not have email address. The investigators, reported if the questionnaire was self-administered or by phone. The investigators used the platform "enquesta.clinic.cat" that guarantees confidentiality and security and no identification details were collected.

Other variables collected: Socio-demographic data, such as gender, age, nationality, civil status (married, single, widow/widower, in a relationship), housing status (living alone or not), educational level (compulsory school, upper secondary school or university), and employment status (still working or not), and review clinical records, like length of Medicalized Hotel stay (days of admission), inpatient's unit (those who had been in a ICU), patients discharge destination and comorbidities (Charlson Comorbidity Index). The data collected from the medical history database were encrypted and stored in an internal and safety server.

All participants were informed in advance about the aim of the study. They received all recommendations given by legal services of the Hospital Clinic and were invited to participate. The confirmation of the study participation, as well as allowing the researchers to use the information collected from medical history, will be made by clicking the link to access into the questionnaire. This study was approved by the Ethics and Investigation Committee of the Hospital Clinic (CEIm).

• Study Type: Observational
• Enrollment (Actual): 517

Contacts and Locations

Study Locations

• Spain
  • Barcelona, Spain, 08036
    • Carme Hernández

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

517 patients admitted to Medicalitzed Hotel with confirmed SARS-CoV2 infection from March 25th to May 8th

Description

Inclusion Criteria:

• All patients admitted in Medicalized Hospital who agreed to participate in the study.

Exclusion Criteria:

• Not localized, language barrier, dementia.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Picker Patient Experience Questionnaire	An adapted shorter version of The Picker Patient Experience Questionnaire, validated into Spanish and Catalan was used to identify whether exist any problem in the healthcare provided. It consists of 15 questions distributed to eight dimensions of care: respect, coordination, information/communication/education, physical comfort, emotional support, involvement of relatives, transition and continuity and finally overall impression. The questions have from two ("yes" or "no") responses to four answer options ("yes", "yes, to some extend", "no" or "I didn't need to"). Neutral answers, such as "I did not need to", and the most positive answer are coded as a "non-problem" (score = 0). The remaining responses are coded as "problems" (score = 1). The PPE-15 has previously been found to be valid and reliable.	one month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Open questions	Four open questions were included in the questionnaire, which enclosed what worried the participants the most, which aspects did they like and which ones they dislike about the medicalized hotel and what will they improve. Those were analysed in a qualitative technique, using the MAXQDA program. This informatics program led importing, transcribing and analysing the information obtained, by keeping the most relevant data and categorising it after having done a correct codification. All the information obtained will rest anonymous.	one month

Collaborators and Investigators

• Sponsor: Hospital Clinic of Barcelona
• Investigators: Principal Investigator: Carme Hernandez, PhD, Hospital Clínic

Publications and helpful links

General Publications

• Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-733. doi: 10.1056/NEJMoa2001017. Epub 2020 Jan 24.
• Hernandez C, Aibar J, Seijas N, Puig I, Alonso A, Garcia-Aymerich J, Roca J. Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment. Int J Integr Care. 2018 May 16;18(2):12. doi: 10.5334/ijic.3431.
• Bertran MJ, Vinaras M, Salamero M, Garcia F, Graham C, McCulloch A, Escarrabill J. Spanish and Catalan translation, cultural adaptation and validation of the Picker Patient Experience Questionnaire-15. J Healthc Qual Res. 2018 Jan-Feb;33(1):10-17. doi: 10.1016/j.cali.2017.12.004. Epub 2018 Feb 14.

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2020
• Primary Completion (Actual): May 31, 2020
• Study Completion (Actual): June 6, 2020

Study Registration Dates

• First Submitted: June 11, 2020
• First Submitted That Met QC Criteria: August 6, 2020
• First Posted (Actual): August 7, 2020

Study Record Updates

• Last Update Posted (Actual): August 7, 2020
• Last Update Submitted That Met QC Criteria: August 6, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: Hospital Hotel
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: Medicalitzed Hotel COVID-19

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Study Data/Documents

1. Informed Consent Form

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No