Can community and hospital medicine meet? A novel integrative care experience at Assuta University Medical Center

The ageing of the population, along with the rise in chronic complex illnesses, requires extensive interprofessional, individualized care, mainly in the community, but also in hospitals. Fragmentation results in suboptimal care, higher cost due to duplication and poor quality of care. Hence, collaboration between health systems is essential to prevent further complications and provide enhanced medical care to patients. Integrative care creates bridges between community and hospital health. Integration should be pursued at different levels within a system to facilitate the continuous, comprehensive, and coordinated delivery of services to individuals and populations. To be applied and to make a difference in patient care and outcome, its significance needs to be understood and embedded at the management level. Health systems should abandon familiar paradigms and collaborate with other health systems on the macro level. Several studies describe integrative care from its different aspects. Division of integration into levels: systemic to clinical, horizontal vs longitudinal and according to the degree of integration (from linkage to full integration). Maccabi Health Services is the first Israeli health organization to place an integrative care team at Assuta Hospital in Ashdod. The multiprofessional team, situated in the hospital, sees every Maccabi patient in the hospital. Through close communication and collaborative work with the hospital team – a shared continuity of the care plan is prepared. The team coordinates future care in the community from the hospital to ease the release process and improve outcomes

Can community and hospital medicine meet? A novel integrative care experience at Assuta University Medical Center.

The ageing of the population, along with the rise in chronic complex illnesses, requires extensive interprofessional, individualized care, mainly in the community, but also in hospitals. Fragmentation results in suboptimal care, higher cost due to duplication and poor quality of care. Hence, collaboration between health systems is essential to prevent further complications and provide enhanced medical care to patients. Integrative care creates bridges between community and hospital health. Integration should be pursued at different levels within a system to facilitate the continuous, comprehensive, and coordinated delivery of services to individuals and populations. To be applied and to make a difference in patient care and outcome, its significance needs to be understood and embedded at the management level. Health systems should abandon familiar paradigms and collaborate with other health systems on the macro level. Several studies describe integrative care from its different aspects. Division of integration into levels: systemic to clinical, horizontal vs longitudinal and according to the degree of integration (from linkage to full integration). Maccabi Health Services is the first Israeli health organization to place an integrative care team at Assuta Hospital in Ashdod. The multiprofessional team, situated in the hospital, sees every Maccabi patient in the hospital. Through close communication and collaborative work with the hospital team – a shared continuity of the care plan is prepared. The team coordinates future care in the community from the hospital to ease the release process and improve outcomes. </jats:p

Unique patterns of healthcare utilization following the opening of the Samson Assuta Ashdod University Hospital

Abstract Our aim was to examine the influence of the market entry of Samson Assuta Ashdod University Hospital on community and hospital-based healthcare utilization (HCU). A retrospective study was conducted among Maccabi Health Services enrollees in the regions of Ashdod (n = 94,575) and Netanya (control group, n = 80,200) before and after this market entry. Based on difference-in-differences framework, we examined the change in HCU of Ashdod region’s enrollees compared to the control group and following the market entry using multivariable generalized estimating equations models. Our results revealed that, as hypothesized, after the market entry and compared to the control group, there was a 4% increase in specialists visits not requiring referral (RR = 1.04, 95% CI 1.03–1.06, p < 0.001), a 4% increase in MRI and CT scans (RR = 1.04, 95% CI 1.01–1.08, p = 0.022), and a 33% increase in emergency room visits (RR = 1.33, 95% CI 1.29–1.38, p < 0.001). Unexpectedly, no changes were observed in the number of hospital admissions (RR = 1.05, 95% CI 0.97–1.14, p = 0.250), and hospitalization days (RR = 0.99, 95% CI 0.94–1.04, p = 0.668). Moreover, and unexpectedly, there was a 1% decrease in primary care physician visits (RR = 0.99, 95% CI 0.98–1.00, p = 0.002), a 11% decrease in specialists visits requiring a referral (RR = 0.89, 95% CI 0.86–0.91, p < 0.001), and a 42% decrease in elective surgeries (RR = 0.58, 95% CI 0.55–0.60, p < 0.001). We conclude that this market entry was not translated to an increase in utilization of all services. The unique model of maintaining the continuity of care that was adopted by the hospital and patients’ loyalty may led to the unique inter-relationship between the hospital and community care

Hypertriglyceridemia Induced Pancreatitis: plasmapheresis or conservative management?

Introduction Hypertriglyceridemia-induced acute pancreatitis (HIAP) may result in severe morbidity and mortality. The most effective management strategy is unknown. While plasmapheresis is often performed, it is possible that a conservative approach which includes fasting, intravenous fluids and high-dose insulin, may be successful. Objectives To compare the 28 day mortality and morbidity parameters among patients admitted to the intensive care unit (ICU) due to HIAP when treated conservatively, as compared to patients who were treated with plasmapheresis. Materials and Methods A retrospective study was performed, including all patients at least 18 years of age who were admitted to the ICU between the years 2010 to 2020 with diagnosis of HIAP. Patients underwent plasmapheresis or were managed conservatively. Collected data included patient demographics, chronic illness and medications, hospital and ICU admission times, 28-day mortality, need for ventilation, number of ventilation days, need for inotropic support, daily triglyceride levels, APACHE II score, lactate on admission, need for dialysis, antibiotic treatment, surgical or percutaneous intervention. Results The study included 29 patients. Twenty two patients were treated conservatively and 7 patients with plasmapheresis. There were no significant statistical differences between the groups regarding demographic parameters, chronic disease and medications. Furthermore, on ICU admission and during the subsequent 4 days APACHE score, serum lactate and triglyceride levels were similar between the groups. There was no significant difference in mortality. However, plasmapheresis was associated with greater morbidity (longer admission times, need for ventilation and number of ventilation days, need for inotropic support and dialysis, and invasive surgical intervention). Finally, when compared to conservative management, the rate of serum triglyceride decrease was not improved following plasmapheresis. Conclusion Efficacy of conservative treatment in lowering the serum triglyceride level in HIAP is similar to plasmapheresis. Due to the small patient cohort further prospective studies are needed to confirm these findings. </jats:sec