Preventive home visits are suited for patients with reduced mobility, such as older people. Healthcare needs for older patients are expected to increase due to the extended life expectancy estimated in coming years. The implementation of low-cost, patient-centered methodologies may buffer this rise in health care costs without affecting the quality of service. In order to find the best home care model with less investment, this paper describes a study protocol comparing two models of home care for older people. We describe a quasi-experimental study that compares the outcome of two different home care models already implemented in two primary care centers in Badalona (Barcelona, Spain). The traditional model (control model) is integrated in the sense that is continuous, the same primary care center team looks after its assigned patients both at the center and in preventive home visits. The new functional home care model (study model), consisting of a highly trained team, is specifically designed to meet patient needs and give total attention to preventive home interventions. The study will start and end on the expected dates, June 2018 to October 2020, and include all patients over 65 years old already enrolled in the home care programs of the primary care centers selected. The primary endpoint assessed will be the difference in hospitalization days between patients included in both home care programs. Other variables regarding health status, quality of care and resource utilization will also be compared between the two models. The study in progress will assess whether a functional and highly trained home care team will meet the ever-aging population needs in terms of cost and health outcomes better than a traditional, integrated one. Lessons learned from this pilot study will provide guidelines for a future model of home care based on the IHI Triple Aim: better care, better health, and lower costs. Registered in ClinicalTrials.gov (Identifier: NCT03461315; March 12, 2018).

中文翻译：

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比较初级环境中老年人家庭护理的两种模式的准实验试验的研究方案


预防性家访适合行动不便的患者，例如老年人。由于未来几年预期寿命的延长，预计老年患者的医疗保健需求将会增加。实施低成本、以患者为中心的方法可以在不影响服务质量的情况下缓冲医疗保健成本的上升。为了找到投资较少的最佳家庭护理模式，本文描述了一项研究方案，比较两种老年人家庭护理模式。我们描述了一项准实验研究，该研究比较了巴达洛纳（西班牙巴塞罗那）两个初级保健中心已经实施的两种不同家庭护理模式的结果。传统模型（控制模型）在连续意义上是集成的，同一初级保健中心团队在中心和预防性家访中照顾其指定的患者。新的功能性家庭护理模式（研究模式）由训练有素的团队组成，专为满足患者需求而设计，并全面关注预防性家庭干预措施。该研究将于预计日期（2018 年 6 月至 2020 年 10 月）开始和结束，并包括所有已参加所选初级保健中心家庭护理计划的 65 岁以上患者。评估的主要终点将是两个家庭护理计划中患者住院天数的差异。有关健康状况、护理质量和资源利用的其他变量也将在两个模型之间进行比较。正在进行的研究将评估一支功能齐全且训练有素的家庭护理团队是否能够比传统的综合护理团队更好地满足日益老龄化的人口在成本和健康结果方面的需求。 从这项试点研究中吸取的经验教训将为基于 IHI 三重目标的未来家庭护理模式提供指导：更好的护理、更好的健康和更低的成本。在 ClinicalTrials.gov 注册（标识符：NCT03461315；2018 年 3 月 12 日）。