A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, n=13) were significantly lower (p<0.01) than the hospital group ($2543($ , CI95% $1766

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease

Nicholson¹,

Bowler²,

Jackson³

et al. 2001

“…10 Many improvements in health outcomes have been demonstrated with HITH studies. [11][12][13][14][15][16] Introduced into Australia in 1994, 17 it is rarely acknowledged that most of these important initiatives were preceded by extensive research and implementation of intensive home-based models of mental health care, e.g. assertive mobile 7-day and night community-based mental health teams.…”

Section: Persistent Long-term and Recurrent Conditionsmentioning

confidence: 99%

The future of community-centred health services in Australia: lessons from the mental health sector

Rosen

Gurr

Fanning

2010

Abstract* It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. * Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospitalcentred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospitalcentred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. * The reasons for these trends are explored. * The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. * Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services.What is known about the topic? Community-centred health care has been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions, e.g. in mental health service systems. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What does this paper add? Despite this global consensus, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends and possible solutions are explored. What are the implications for practitioners? Unless this trend is reversed, the loss of convenient public access to community health services at shopping and transport hubs and the consequent compromising of intensive home-based clinical care, will lead to a deterioration of preventative interventions and the health care of long-term conditions, contrary to international studies and reviews.

“…Its development has been supported by studies that have reported lower running costs, [1][2][3][4][5] less confusion, 5 fewer urinary and bowel complications, 5 decreased nosocomial infection and greater patient satisfaction. [5][6][7] The range of conditions treated by HITH and the evidence supporting its efficacy and safety are growing.…”

mentioning

confidence: 99%

Medical model for hospital in the home: effects on patient management

Tran¹,

Taylor²

2009