Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

Anne-Laure Feral-Pierssens, Gustave Toury, Fatima Sehimi, Nicolas Peschanski, Saïd Laribi, Amélie Carpentier, Magali Kraif, Clément Carbonnier, François-Xavier Duchateau, Yonathan Freund, Philippe Juvin, EPIGER IRU-SFMU study group, Patrice Serre, Aurélie Arnaud, Edouard Dugat, Céline Occelli, Thomas Lanoux, Edouard Jacquet, Céline Moretto, Arnaud Devillard, Aurélia Bordais, Olivier Maurin, Magali Kraif, Aurélie Caffier, Jonathan Duchenne, Stéphane Gillet, Ester Milojevitch, Cindy Tissier, Sunde Kilic, Véronique Uchlinger, Nicolas Gonzalez, Vincent Lacoste, Sébastien Pouzoulet, Abdo Khoury, Philippe Marguet, Claude Zamour, Arnaud Proust, Anastasia Dessena, Frédéric Saura, Aurélie Schindler, Emilie Gelin, Ludivine Tendron, Isabelle Cailleux, Marie-Hélène Basso, Vanessa Houze-Cerfon, Julie Oudet, Bernard Ah-Koon, Thierry Babet, Justine Bereau, Rishad Vally, Emilie Souchaud, Catherine Scouarnec, Olivier De Stabenrath, Olivier Vuillot, Isabelle Giraud, Laurent Bebien, Nicolas Chauvel, Thomas Le Normand, Cécile Rouchy, Isabelle Arnault, Vivien Brenkmann, Damien Viglino, Ernest Maiello, Olivier Matas, Rémy Lemarchand, Yves Duffait, Cécile Bonhomme, Mikaël Martinez, Alain Viallon, Quentin Legoff, Benjamin Blonstein, Pierre-Arnaud Fort, Oriane Vicenzi, Valérie Ruche, Anthony Millet, Tahar Chouihed, Daniel Baugnon, Nathalie Daniel, Bertrand Boulanger, Julien Galant, Henri Le Hot, Christophe Rothmann, Isabelle Guenot, Mathieu Cochonneau, Nadia Smaiti, Patricia Lachery, Eric Wiel, Sylvain Thiriez, Lila Abdelli, Amélie Carpentier, Rachid Kasdali, Thierry Ramaherison, Thomas Guidez, Charles Bailly, Fabien Poher, Annick Idrissi, Karine Humbert, Paul Andregnette, Daniel Pic, Nicolas Dublanchet, Géraldine Giroud, Guillaume N'Guyen, Laure Jainsky, Marc Lacrouts, Marie-Pierre Liepa, Gaëlle Esturoune, Arnaud Ximenes, Ialasoa Randrianasolo, Mélanie Mathe, Hélène Chable, Géraldine Le Cardinal, Anne-Marie Zix-Minni, Pierrick Le Borgne, Fanny Schweitzer, Kasarra Ben Hammouda, Jacques Schmitt, Gaëlle Compte, Marine Delaroche, Christian Di Filippo, Véronique Potinet, Olivier Regal, Alireza Nahani, Jacques Faivre, Teddy Sturiale, Mohammed Touil, Mario Di Rollo, Olivier Laine, Mathieu Gerain, Marc Latappy, François-Xavier Ageron, Claire Vallenet, Agathe Leleu, Morgan Blandin, Anne-Laure Paquet, Marie-Laurence Fievet-Brochot, Erwin Hansconrad, Benoît Vivien, Alessandra Principe, Pierre-Clément Thiebaud, Eloïse Trabattoni, Eric Burggraff, Emmanuel Boust, Valérie Massol, Xavier Benet, Quentin Foubert, Benoît Jardel, Mélanie Roussel, Luc-Marie Joly, Mariane Ovtcharenko, Karim Bedrici, Mohamed Abdeljaouad, Carole Mauger-Briche, Laurence Berton, Ludovic Dalle, Mathieu Violeau, Loïc Amizet, Fanny Fontaine, Anaïs Colonna, Jean Tida, Emelyne Cwicklinski, Philippe Fradin, Christine Vallejo, Lotfi Frigui, Samia Bregigeon, Muriel Porche, Arnaud Le Jan, Jean-Philippe Desclefs, Hery Andrianjafy, Laura Wajzer, Ta Trung Hung, Sébastien Beaune, Hugo Lenglet, Gaëlle Le Bail, Anna Bouchara, Marie-Clément Kouka, Mathias Wargon, Steven David, Mohamed Khalid, Catherine Phlippoteau, Stéphane Diez, Jean Sende, Xavier Baermann, Catherine Legall, Aurélie Fehre, Célia Etiennar, Nathalie Roudiak, Julie Talfournier, Chloé Lefebvre, Yann-Erick Claessens, Pierre-Nicolas Carron, Fabrice Dami, Esther Popotte, Ahmed Belkouch, Jean-Marc Pujo, Anne-Laure Feral-Pierssens, Gustave Toury, Fatima Sehimi, Nicolas Peschanski, Saïd Laribi, Amélie Carpentier, Magali Kraif, Clément Carbonnier, François-Xavier Duchateau, Yonathan Freund, Philippe Juvin, EPIGER IRU-SFMU study group, Patrice Serre, Aurélie Arnaud, Edouard Dugat, Céline Occelli, Thomas Lanoux, Edouard Jacquet, Céline Moretto, Arnaud Devillard, Aurélia Bordais, Olivier Maurin, Magali Kraif, Aurélie Caffier, Jonathan Duchenne, Stéphane Gillet, Ester Milojevitch, Cindy Tissier, Sunde Kilic, Véronique Uchlinger, Nicolas Gonzalez, Vincent Lacoste, Sébastien Pouzoulet, Abdo Khoury, Philippe Marguet, Claude Zamour, Arnaud Proust, Anastasia Dessena, Frédéric Saura, Aurélie Schindler, Emilie Gelin, Ludivine Tendron, Isabelle Cailleux, Marie-Hélène Basso, Vanessa Houze-Cerfon, Julie Oudet, Bernard Ah-Koon, Thierry Babet, Justine Bereau, Rishad Vally, Emilie Souchaud, Catherine Scouarnec, Olivier De Stabenrath, Olivier Vuillot, Isabelle Giraud, Laurent Bebien, Nicolas Chauvel, Thomas Le Normand, Cécile Rouchy, Isabelle Arnault, Vivien Brenkmann, Damien Viglino, Ernest Maiello, Olivier Matas, Rémy Lemarchand, Yves Duffait, Cécile Bonhomme, Mikaël Martinez, Alain Viallon, Quentin Legoff, Benjamin Blonstein, Pierre-Arnaud Fort, Oriane Vicenzi, Valérie Ruche, Anthony Millet, Tahar Chouihed, Daniel Baugnon, Nathalie Daniel, Bertrand Boulanger, Julien Galant, Henri Le Hot, Christophe Rothmann, Isabelle Guenot, Mathieu Cochonneau, Nadia Smaiti, Patricia Lachery, Eric Wiel, Sylvain Thiriez, Lila Abdelli, Amélie Carpentier, Rachid Kasdali, Thierry Ramaherison, Thomas Guidez, Charles Bailly, Fabien Poher, Annick Idrissi, Karine Humbert, Paul Andregnette, Daniel Pic, Nicolas Dublanchet, Géraldine Giroud, Guillaume N'Guyen, Laure Jainsky, Marc Lacrouts, Marie-Pierre Liepa, Gaëlle Esturoune, Arnaud Ximenes, Ialasoa Randrianasolo, Mélanie Mathe, Hélène Chable, Géraldine Le Cardinal, Anne-Marie Zix-Minni, Pierrick Le Borgne, Fanny Schweitzer, Kasarra Ben Hammouda, Jacques Schmitt, Gaëlle Compte, Marine Delaroche, Christian Di Filippo, Véronique Potinet, Olivier Regal, Alireza Nahani, Jacques Faivre, Teddy Sturiale, Mohammed Touil, Mario Di Rollo, Olivier Laine, Mathieu Gerain, Marc Latappy, François-Xavier Ageron, Claire Vallenet, Agathe Leleu, Morgan Blandin, Anne-Laure Paquet, Marie-Laurence Fievet-Brochot, Erwin Hansconrad, Benoît Vivien, Alessandra Principe, Pierre-Clément Thiebaud, Eloïse Trabattoni, Eric Burggraff, Emmanuel Boust, Valérie Massol, Xavier Benet, Quentin Foubert, Benoît Jardel, Mélanie Roussel, Luc-Marie Joly, Mariane Ovtcharenko, Karim Bedrici, Mohamed Abdeljaouad, Carole Mauger-Briche, Laurence Berton, Ludovic Dalle, Mathieu Violeau, Loïc Amizet, Fanny Fontaine, Anaïs Colonna, Jean Tida, Emelyne Cwicklinski, Philippe Fradin, Christine Vallejo, Lotfi Frigui, Samia Bregigeon, Muriel Porche, Arnaud Le Jan, Jean-Philippe Desclefs, Hery Andrianjafy, Laura Wajzer, Ta Trung Hung, Sébastien Beaune, Hugo Lenglet, Gaëlle Le Bail, Anna Bouchara, Marie-Clément Kouka, Mathias Wargon, Steven David, Mohamed Khalid, Catherine Phlippoteau, Stéphane Diez, Jean Sende, Xavier Baermann, Catherine Legall, Aurélie Fehre, Célia Etiennar, Nathalie Roudiak, Julie Talfournier, Chloé Lefebvre, Yann-Erick Claessens, Pierre-Nicolas Carron, Fabrice Dami, Esther Popotte, Ahmed Belkouch, Jean-Marc Pujo

Abstract

Background: For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources' use and patients' outcome.

Methods: A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for "having difficulties coping at home". The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints.

Results: One thousand one hundred sixty-eight patients were included, median age 86(83-89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68-2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65-1.30]). Assisted patients had a lower risk of being admitted for "having difficulties coping at home" (OR = 0.59;95%CI [0.38-0.92]).

Conclusion: Professional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications.

Trial registration: Clinicaltrial.gov - NCT02900391 , 09/14/2016, retrospectively registered.

Keywords: Elderly; Emergency care; Healthcare access; Home services; Loss of autonomy.

Conflict of interest statement

SL, NP have relevant financial activities outside the submitted work. SL reports personal fees from Aspen, Astra-Zeneca, Bristol-Myers Squibb, Novartis and Roche; NP reports personal fees from Vygon, AstraZeneca, Bayer and non-financial support from Vygon; and the remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of included patients and existing home services

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