Home care and readmissions
DOI:
https://doi.org/10.5712/rbmfc21(48)4524Keywords:
Home care services, Patient readmission, Continuity of patient careAbstract
Introduction: The changes resulting from the demographic and epidemiological transition, with a consequent increase in life expectancy and the prevalence of non-communicable chronic degenerative diseases, raise the need for the development and implementation of public policies. Within the scope of the Brazilian Unified Health System (SUS), home care is configured as a substitutive or complementary health care modality, consisting of health promotion, disease prevention and treatment, and rehabilitation actions carried out at home, ensuring continuity of care and its integration into health care networks. Among its main tasks is to avoid hospital readmissions. Objective: The objective of this work was to identify readmissions of patients followed up by a home care service (HCS) from June 2022 to May 2023, characterizing them in terms of cause and length of follow-up, in addition to defining the hospital readmission rate of the HCS and analyzing the socio-epidemiological profile of patients who were readmitted. Methods: This was a retrospective cross-sectional study, in which the service’s medical records and database were reviewed in pursuit of the objectives described above. Results: Among the main findings, in a sample of 300 readmissions out of a total of 2,713 patients (readmission rate of 11.06%), the leading causes were infectious (128), neoplastic (38), and undefined symptoms (34). The remaining causes were less representative. The mean follow-up time by the HCS until readmission was 25 days. Twenty-six (8.67%) occurred within less than 48 hours of follow-up. Conclusions: The study enhances the understanding of the profile of patients followed up by an HCS that progressed to readmission. Identifying comorbidities associated with these readmissions – many of them related to primary care-sensitive conditions – reveals opportunities for interventions capable of strengthening home-based care and reducing potentially preventable hospitalizations.
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Copyright (c) 2026 Luísa Nakashima Pereira1, Felipe Sperotto Peruzzo, Konrad Gutterres Soares, Raquel Jeanty de Seixas Mestriner
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