Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study
Authors: Feral-Pierssens Anne-Laure , Toury Gustave , Sehimi Fatima , Peschanski Nicolas , Laribi Saïd , Carpentier Amélie , Kraif Magali , Carbonnier Clément , Duchateau François-Xavier , Freund Yonathan , Juvin Philippe ,   the EPIGER IRU-SFMU study group, Serre Patrice , Arnaud Aurélie , Dugat Edouard , Occelli Céline , Lanoux Thomas , Jacquet Edouard , Moretto Céline , Devillard Arnaud , Bordais Aurélia , Maurin Olivier , Kraif Magali , Caffier Aurélie , Duchenne Jonathan , Gillet Stéphane , Milojevitch Ester , Tissier Cindy , Kilic Sunde , Uchlinger Véronique , Gonzalez Nicolas , Lacoste Vincent , Pouzoulet Sébastien , Khoury Abdo , Marguet Philippe , Zamour Claude , Proust Arnaud , Dessena Anastasia , Saura Frédéric , Schindler Aurélie , Gelin Emilie , Tendron Ludivine , Cailleux Isabelle , Basso Marie-Hélène , Houze-Cerfon Vanessa , Oudet Julie , Ah-Koon Bernard , Babet Thierry , Bereau Justine , Vally Rishad , Souchaud Emilie , Scouarnec Catherine , De Stabenrath Olivier , Vuillot Olivier , Giraud Isabelle , Bebien Laurent , Chauvel Nicolas , Le Normand Thomas , Rouchy Cécile , Arnault Isabelle , Brenkmann Vivien , Viglino Damien , Maiello Ernest , Matas Olivier , Lemarchand Rémy , Duffait Yves , Bonhomme Cécile , Martinez Mikaël , Viallon Alain , Legoff Quentin , Blonstein Benjamin , Fort Pierre-Arnaud , Vicenzi Oriane , Ruche Valérie , Millet Anthony , Chouihed Tahar , Baugnon Daniel , Daniel Nathalie , Boulanger Bertrand , Galant Julien , Le Hot Henri , Rothmann Christophe , Guenot Isabelle , Cochonneau Mathieu , Smaiti Nadia , Lachery Patricia , Wiel Eric , Thiriez Sylvain , Abdelli Lila , Carpentier Amélie , Kasdali Rachid , Ramaherison Thierry , Guidez Thomas , Bailly Charles , Poher Fabien , Idrissi Annick , Humbert Karine , Andregnette Paul , Pic Daniel , Dublanchet Nicolas , Giroud Géraldine , N’Guyen Guillaume , Jainsky Laure , Lacrouts Marc , Liepa Marie-Pierre , Esturoune Gaëlle , Ximenes Arnaud , Randrianasolo Ialasoa , Mathe Mélanie , Chable Hélène , Le Cardinal Géraldine , Zix-Minni Anne-Marie , Le Borgne Pierrick , Schweitzer Fanny , Ben Hammouda Kasarra , Schmitt Jacques , Compte Gaëlle , Delaroche Marine , Di Filippo Christian , Potinet Véronique , Regal Olivier , Nahani Alireza , Faivre Jacques , Sturiale Teddy , Touil Mohammed , Di Rollo Mario , Laine Olivier , Gerain Mathieu , Latappy Marc , Ageron François-Xavier , Vallenet Claire , Leleu Agathe , Blandin Morgan , Paquet Anne-Laure , Fievet-Brochot Marie-Laurence , Hansconrad Erwin , Vivien Benoît , Principe Alessandra , Thiebaud Pierre-Clément , Trabattoni Eloïse , Burggraff Eric , Boust Emmanuel , Massol Valérie , Benet Xavier , Foubert Quentin , Jardel Benoît , Roussel Mélanie , Joly Luc-Marie , Ovtcharenko Mariane , Bedrici Karim , Abdeljaouad Mohamed , Mauger-Briche Carole , Berton Laurence , Dalle Ludovic , Violeau Mathieu , Amizet Loïc , Fontaine Fanny , Colonna Anaïs , Tida Jean , Cwicklinski Emelyne , Fradin Philippe , Vallejo Christine , Frigui Lotfi , Bregigeon Samia , Porche Muriel , Le Jan Arnaud , Desclefs Jean-Philippe , Andrianjafy Hery , Wajzer Laura , Hung Ta Trung , Beaune Sébastien , Lenglet Hugo , Le Bail Gaëlle , Bouchara Anna , Kouka Marie-Clément , Wargon Mathias , David Steven , Khalid Mohamed , Phlippoteau Catherine , Diez Stéphane , Sende Jean , Baermann Xavier , Legall Catherine , Fehre Aurélie , Etiennar Célia , Roudiak Nathalie , Talfournier Julie , Lefebvre Chloé , Claessens Yann-Erick , Carron Pierre-Nicolas , Dami Fabrice , Popotte Esther , Belkouch Ahmed , Pujo Jean-Marc 
Published: September 2020

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