New nursing roles for the integrated management of complex chronic and palliative care patients in the region of Valencia/Nuevos perfiles enfermería para el manejo integral de pacientes crónicos complejos y paliativos en la Comunidad Valenciana

The autonomous region of Valencia has a population of 5.1 million divided into 24 health districts and the governing body of the Valencia Health Service is the Valencia health agency (AVS, Agència Valenciana de Salut). In the framework of the plan for improving home care in the region of Valencia [1] a study was carried out between 2005 and 2006, across three of these health districts. The study assessed the quality of home care provided by the two largest agents (by volume of activity): the primary care teams (PCTs—a total of 241, at present) through a home care programme (HCP) and the hospital-at-home (HaH) units, well developed in the AVS region (with a total of 24, at present). Able to attend 1428 patients per day, these HaH units supported 35,802 discharges in 2010. The main objective of the study was to establish a basis for designing improvement interventions in the sphere of home care. Notably, the results demonstrated a fragmentation and lack of continuity of care between HaH units and the HCP for palliative care patients and those with advanced chronic diseases, a very complex group of patients associated with a high use of resources that may jeopardise the sustainability of the system.