Hospital in the home: a randomised controlled trial

Abstract

Objectives To compare treatment of acute illness at home and in hospital, assessing safety, effect on geriatric complications, and patient/carer satisfaction. Design Randomised controlled trial. Setting A tertiary referral hospital affiliated with the University of New South Wales. Participants 100 patients (69% older than 65 years) with a variety of acute conditions, who were assessed in the emergency department as requiring admission to hospital. Interventions Patients were allocated at random to be treated by a hospital‐in‐the‐ home (HIH) service in their usual residence or to be admitted to hospital. Main outcome measures Geriatric complications (confusion, falls, urinary incontinence or retention, faecal incontinence or constipation, phlebitis and pressure areas), patient/carer satisfaction, adverse events, and death. Results There was a lower incidence of confusion (0 v. 20.4% [95% Cl, 9.1%–31.7%); P=0.0005), urinary complications (incontinence or retention) (2.0% [95% Cl, –1.8%, 5.8%) v. 16.3% [95% Cl, 6.0%, 26.6%); P=0.01), and bowel complications (incontinence or constipation) (0 v. 22.5% [95% Cl, 10.7%, 34.1%); P=0.0003) among HIH‐treated patients. No significant difference in number of adverse events and deaths (to 28 days after discharge) in the two groups was found (although numbers were small). Patient and carer satisfaction was significantly higher in the HIH group. Conclusions Home treatment appears to provide a safe alternative to hospitalisation for selected patients, and may be preferable for some older patients. We found high levels of both patient and carer satisfaction with home treatment.

Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

“…The rate and strength of preference for home blood transfusion measured in our patients are consistent with other studies of home care, especially home chemotherapy, conducted in cancer patients [58][59][60][61]. Our results and those from previous studies investigating patients' preferences for home blood transfusion are complementary.…”

Home care—a safe and attractive alternative to inpatient administration of intensive chemotherapies

“…Home care treatment has been investigated in different non-oncologic conditions and following certain medical procedures [1][2][3][4][5][6]. Studies often focused on elderly patients admitted for elective procedures or age-related diseases.…”

“…Home care was associated with significantly shorter hospital stays, fewer geriatric complications, and did not increase the rate of subsequent readmissions [4,6]. Patients and care giving relatives reported high levels of satisfaction following home care treatment [1,4]. A meta-analysis of 22 trials revealed a decreased mortality and readmission rates in elderly patients receiving home care compared with hospital care patients [4].…”

Delirium in elderly home-treated patients: a prospective study with 6-month follow-up

“…Previous RCTs that have investigated the effects of a home-based care setting in delirium prevention differ from our study in that they were not specifically designed to detect incident delirium (Caplan et al 1999) or to report data of patients undergoing a rehabilitation program at home, and thus patients were not acutely ill in the earlier studies (Caplan et al 2006). To our knowledge, this is the first study to identify delirium episodes in hospital-at-home patients constantly throughout the study period.…”

“…It has been previously reported that care at home results in a lower incidence of confusion. In an Australian randomised controlled trial (RCT), older patients who required hospital care were randomised to receive appropriate treatment (all pharmacological and non-pharmacological interventions usually adopted in a traditional geriatric ward for patients with acute medical conditions) either at home or in the hospital: confusion was less common in those treated at home, although these findings were based on a clinical records review (Caplan et al 1999). In a more recent RCT, the same authors demonstrated that home rehabilitation for frail elderly after acute hospitalisation is associated with a lower risk of delirium (Caplan et al 2006).…”