Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial

Utens, Cecile M.A.; Goossens, Lucas; Schayck, Onno C. P. van; Mölken, Maureen P.M.H. Rutten-van; Litsenburg, Walter van; Janssen, Annet; Pouw, Anouschka van der; Smeenk, Frank W.J.M.

doi:10.1016/j.ijnurstu.2013.03.006

Cited by 38 publications

(62 citation statements)

References 27 publications

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“…The explanation for our findings is unclear but may relate to the relatively high LOS reported in this audit by the UK centres and the low level of this form of service across Europe as a whole. Other studies have supported use of early supported discharge services in the absence of a reduction in LOS [40–42] due to patient preference or positive impacts on patients' well-being with use of such services.…”

Section: Discussionmentioning

confidence: 99%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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Section: Discussionmentioning

confidence: 99%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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“…An RCT by Utens et al. () reported that patients expressed a preference for home‐based treatment despite a slightly lower ability to resume activities, and slightly greater rates of feeling unsafe at night. However, generic health‐related quality of life was higher in the hospital care group at 7 days (Utens et al., ).…”

Section: Resultsmentioning

confidence: 99%

“…() suggest a possible reduction in resource utilization associated with a telephone‐based outreach intervention, particularly in relation decreased inpatient and emergency department usage. Factors linked to effective implementation included the coordination of services (Parsons et al., ), home visits prior to hospital discharge, and the clarification of expectations about home visiting (Utens et al., ). Barriers to implementing transitional care included lack of specialist training of community nurses to cater for specific patient's needs (Utens et al., ).…”

Section: Resultsmentioning

confidence: 99%

Transitional care interventions: Relevance for nursing in the community

Coffey

Mulcahy

Savage

et al. 2017

Public Health Nursing

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“…For example feeling safe treating patients at home. However, other results from the effectiveness evaluation [14], patient evaluation [26] and informal caregiver evaluation [Utens et al, Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial. Submitted] are positive and suggest that this probably will not be a large issue.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

Utens

Goossens

Schayck

et al. 2013

BMC Health Serv Res

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BackgroundHospital-at-home is an accepted alternative for usual hospital treatment for patients with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The introduction of hospital-at-home may lead to changes in health care providers’ roles and responsibilities. To date, the impact on providers’ roles is unknown and in addition, little is known about the satisfaction and acceptance of care providers involved in hospital-at-home.MethodsObjective of this survey study was to investigate the role differentiation, role transitions and satisfaction of professional care providers (i.e. pulmonologists, residents, hospital respiratory nurses, generic and specialised community nurses and general practitioners) from 3 hospitals and 2 home care organisations, involved in a community-based hospital-at-home scheme. A combined multiple-choice and open-end questionnaire was administered in study participants.ResultsResponse rate was 10/17 in pulmonologists, 10/23 in residents, 9/12 in hospital respiratory nurses, 15/60 in generic community nurses, 6/10 in specialised community nurses and 25/47 in general practitioners. For between 66% and 100% of respondents the role in early discharge was clear and between 57% and 78% of respondents was satisfied with their role in early discharge. For nurses the role in early discharge was different compared to their role in usual care. 67% of generic community nurses felt they had sufficient knowledge and skills to monitor patients at home, compared to 100% of specialised community nurses. Specialised community nurses felt they should monitor patients. 60% of generic community nurses responded they should monitor patients at home. 78% of pulmonologists, 12% of general practitioners, 55% of hospital respiratory nurses and 48 of community nurses was satisfied with early discharge in general. For coordination of care 29% of community nurses had an unsatisfied response. For continuity of care this was 12% and 10% for hospital respiratory nurses and community nurses, respectively.ConclusionA community-based early assisted discharge for COPD exacerbations is possible and well accepted from the perspective of health care providers’ involved. Satisfaction with the different aspects is good and the transfer of patients in the community while supervised by generic community nurses is possible. Attention should be paid to coordination and continuity of care, especially information transfer between providers.

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Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial

Cited by 38 publications

References 27 publications

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Transitional care interventions: Relevance for nursing in the community

Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

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