The home return support program (PRADO) relies on a selection mechanism that neither the patient nor the general practitioner directly controls. Eligibility is determined by the hospital medical team based on medical, autonomy, and social context criteria. Understanding this filter allows for anticipating care management and avoiding poorly prepared discharges.
PRADO eligibility criteria: who really filters patients
The decision to include a patient in the PRADO program of the Health Insurance does not rest with the treating physician. It is the medical team of the hospital that validates or denies entry into the program, based on an assessment conducted prior to discharge.
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Three axes structure this evaluation:
- Medical criteria stricto sensu: sufficient clinical stability for a return home, absence of post-operative complications requiring prolonged hospital monitoring.
- Autonomy criteria: the patient’s ability to move, manage daily care, or benefit from a supportive environment.
- Social context: housing conditions, isolation, presence or absence of a family caregiver, geographical access to community health professionals.
A patient may therefore be medically stable but excluded from the program if their social environment does not guarantee safe continuity of care. Conversely, a socially well-supported profile is not sufficient if the clinical condition remains unstable.
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PRADO is impossible if the discharge must lead to home hospitalization (HAD). The two programs are mutually exclusive: HAD falls under a different circuit, with heavier technical resources and medical supervision.
Pathologies and situations qualifying for PRADO service
The scope of the program has gradually expanded since its launch. The situations covered today exceed the initial maternity-focused framework.
The active components cover maternity discharges, surgical interventions (including orthopedic), heart failure decompensation, COPD exacerbation, stroke, and TIA. Patients aged 75 and over are eligible regardless of the reason for hospitalization, making it the broadest aspect of the program.
We observe that this extension to older adults remains underutilized. In practice, hospital teams do not systematically offer PRADO to geriatric patients hospitalized for reasons other than chronic pathology. The workload of Health Insurance advisors (CAM) and the number of partner establishments limit actual coverage.
Variation by affiliation scheme
The program is not reserved for the general scheme. ENIM (National Establishment for Marine Invalids) has extended it to its insured and beneficiaries. This variation by scheme means that access to PRADO also depends on the affiliation fund, not just on the pathology or the establishment.
In practice, an insured person under a special scheme must check with their fund whether the service is active for their profile. This information does not always reach the hospital teams, who primarily work with the flows of the general scheme.
Role of community professionals and operational conditions
The community aspect of the program imposes specific constraints on nurses, pharmacists, and treating physicians who wish to participate in the PRADO framework.
For liberal nurses, participation requires registering as a PRADO provider with the CPAM, being identified by partner hospitals, and complying with the NGAP for billing procedures. The use of approved teletransmission software is mandatory.
A point often overlooked: the transmission of information to the treating physician must occur within 48 hours following the first home visit. This timeframe conditions the smoothness of the care pathway and, if not respected, may compromise coordination with the referring physician.
The pharmacist in the PRADO circuit
The community pharmacist is involved in dispensing medications at home, particularly for poly-medicated or mobility-reduced patients. Their role includes verifying the consistency of the discharge prescription with the patient’s usual treatment.
The remuneration for this act follows a specific framework, distinct from the classic dispensing at the counter. We recommend that interested pharmacists contact their CPAM to learn about the billing modalities applicable to their situation.
Concrete limits of the program and cases of PRADO refusal
Admission to PRADO is never automatic. Three situations frequently lead to a refusal or impossibility of implementation:
- A discharge directed towards an HAD, which effectively excludes the program.
- A deterioration in health status between the eligibility assessment and the actual discharge date.
- An insufficient social context to guarantee the safety of the return home (inadequate housing, total absence of support within a reasonable geographical perimeter).
The territorial deployment remains uneven. Not all healthcare establishments participate in the program, and the density of available community professionals as PRADO providers varies by health basin.
For a patient who is denied access to the program, no formal recourse exists within the program itself. The decision of the hospital medical team prevails. However, the treating physician can organize a coordinated return home outside the PRADO framework, but without the logistical support of the Health Insurance advisor.
The question to ask before a scheduled hospitalization is not “am I entitled to PRADO,” but rather: does my establishment participate in the program and does my medical-social profile meet the criteria of the care team. Checking these two points in advance with the admissions service remains the most reliable way to anticipate the next steps.