Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?

Shepperd, Sasha; Butler, Christopher Collett; Cradduck-Bamford, Andrea; Ellis, Graham; Gray, Alastair; Hemsley, Anthony; Khanna, Pradeep; Langhorne, Peter; Mort, Sam; Ramsay, Scott; Schiff, Rebekah; Stott, David J.; Wilkinson, Angela; Yu, Ly-Mee; Young, John

doi:10.7326/m20-5688

Cited by 83 publications

(72 citation statements)

References 30 publications

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“…The first participant was recruited on 14th March 2015. Twenty three participants were not included in the analysis due to withdrawing consent to use their data ( N = 10), a deterioration in health that prevented data collection ( N = 4), previously recruited ( N = 4), lived outside the CGAHAH area ( N = 1), <65 years ( N = 1) or withdrew after randomisation with incomplete data ( N = 3; see Figure 1 ) [ 22 ]. Thirty-seven participants allocated to CGAHAH were immediately admitted to hospital due to a further decline in health, and of those randomised to hospital 76/345 (22.0%) were instead admitted to CGAHAH due to participant preference for CGAHAH or a high rate of hospital bed occupancy diverted participants to CGAHAH 1 .…”

Section: Resultsmentioning

confidence: 99%

“…We recruited participants between 14th March 2015 and 18th June 2018. We collected data on participant characteristics, health service use over the previous 6 months to adjust for differences in previous utilisation of health services, measures of outcome at baseline, quality of life measured by the EuroQol (EQ-5D-5L) at 6 months and clinical outcome data at one and 6 months (reported elsewhere) [ 22 ]. We included data on the resources used by those who died up to the follow-up time that preceded their death.…”

Section: Methodsmentioning

confidence: 99%

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Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

et al. 2021

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Background hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people. Objective to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. Design/intervention a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. Participants/setting older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355). Measurements quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases. Results adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean −£2,265, 95% CI: −4,279 to −252), and remained less costly with the addition of informal care costs (mean difference −£2,840, 95% CI: −5,495 to −185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to −£2,458 (95% CI: −4,977 to 61) and societal costs remained significantly lower (−£3,083, 95% CI: −5,880 to −287). There was little change to quality adjusted survival. Conclusions CGA HAH is a cost-effective alternative to admission to hospital for selected older people.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

et al. 2021

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“…Thus, if higher hospital utilisation potentially reflects greater vigilance by more confident family caregivers, then the under-utilisation of appropriate hospital care by patients of caregivers who feel less prepared is potentially an important opportunity for teaching. While other studies of community-dwelling older adults found that increased caregiver depression and strain were associated with increased hospital utilisation for care recipients,9 10 we are not aware of any published HomePal studies15 23–25 nor home-based primary care26–31 or hospital-at-home32 33 models reporting on the relationship between caregiver factors and patient utilisation of hospital-based services.…”

Section: Discussionmentioning

confidence: 83%

Hospital utilisation in home palliative care: caregiver health, preparedness and burden associations

Nguyen

Haupt

Duan

et al. 2022

BMJ Support Palliat Care

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BackgroundPrior studies show that family caregiver factors influence patient outcomes. The purpose of this analysis was to determine the association between family caregiver self-rated health, perception of preparedness and burden at the time of patient admission to home palliative care (HomePal) with downstream patient hospital utilisation and time to hospice enrolment and death.MethodsData for this cohort study (n=441) were drawn from a trial testing two models of HomePal. Caregiver self-rated health, preparedness (Preparedness for Caregiving Scale, CPS) and burden (Zarit-12) were measured at admission to HomePal. Caregivers were categorised as having good/very good/excellent or fair/poor health, scoring above or below the CPS median score (23), or having no/mild (0–10), moderate (11-20) or high (>20) burden. Proportional hazard competing risk models assessed the association between caregiver factors with hospital utilisation (emergency department visits, observation and inpatient stays).ResultsPatients whose caregivers reported poor health and low preparedness received more visits by home health aides and social workers, respectively (both, p<0.05). Adjusted models showed that worse caregiver health (HR: 0.69 (95% CI 0.52 to 0.92), p=0.01), low preparedness (HR: 0.73 (95% CI 0.57 to 0.94), p=0.01) and high burden (HR: 0.77 (95% CI 0.56 to 1.06), p=0.10) were associated with lower risk for hospital utilisation. There were no significant associations between caregiver factors with time to patient enrolment in hospice or death in adjusted models (both, p>0.05).ConclusionProspective studies are needed to understand how greater in-home supports for family caregivers with poor health could help achieve quality palliative care that aligns with families’ priorities.Trial registration numberNCT03694431; ClinicalTrials.gov.

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“…While the evidence base in support of HaH is imperfect, it does provide a degree of confidence that HaH achieves similar outcomes to hospital bed-based care in selected patients. The practical execution of HaH trials is becoming more difficult as institutional enthusiasm to adopt HaH limits recruitment [56] and high hospital bed occupancy results in poor adherence to an assignment (in the most recent instance, despite 2:1 allocation in favor of the HaH intervention) [58]. The balance of risk is no longer in equipoise and the justification for further interventional trials to provide more precise estimates of the impact on HaH on mortality and other outcomes is waning.…”

Section: Established Models Of Hah and The Current Evidence Basementioning

confidence: 99%

Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population

Knight

Lasserson

2021

J Intern Med

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Recent trends across Europe show a year‐on‐year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.

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Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?

Cited by 83 publications

References 30 publications

Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?

Hospital utilisation in home palliative care: caregiver health, preparedness and burden associations

Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population

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