• S Hannane, K Sacre, J-F Alexandra, A Dossier, T Goulenok, C Bernard, M Nolland, D van Gysel, T Papo, and M-P Chauveheid.
• Université Paris-Diderot, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France.
• Rev Med Interne. 2020 Nov 1; 41 (11): 727-731.

IntroductionA unique structure devoted to post-acute and rehabilitation care for patients under 75 with multiple comorbidities has been created within the Department of Internal Medicine, Bichat Hospital, Paris. We aim to report on demographic factors, clinical characteristics and outcomes of patients hospitalized in this pilot structure.MethodsAll consecutive adult patients admitted between May 2017 and May 2018 were retrospectively reviewed.ResultsAnalysis was performed on 61 (61 [24-75] years-old) admitted patients. The median length of hospital stays was 108 [13-974] days. At admission, the median Charlson comorbidity index was 6 [0-12] predicting a 10-year survival of 21 [0-99]%. Most patients were unemployed (83.6%) and had very low-income (< national minimum wage in 65.6% of cases). At hospital discharge, most patients (85.4%) were able to return home. The complete resolution of health problems occurred in most cases (65.6%) and was associated with a lower probability of both hospital readmission and death 1-year after discharge.ConclusionThe structure served a high percentage of patients with major and complex health needs but limited access to care due to individual disabilities, low-income and underinsured status. However, despite major health disorders, functional limitations, and vulnerability, admission improved patient outcomes and reduced excess hospital readmissions in most cases.Copyright © 2020. Published by Elsevier Masson SAS.

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