Substitutive “Hospital at Home” Versus Inpatient Care for Elderly Patients with Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Randomized, Controlled Trial

Abstract

Physician-led substitutive hospital-at-home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months, lower healthcare costs, and better quality of life.

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

“…68,75 Both were comparing 'hospital at home' with UC and had substantial SM components. One trial 75 was excluded because all patients were seen in the ED then randomised to home compared with hospital (and therefore patients were not admitted at all unless in the control group).…”

“…68,75 Both were comparing 'hospital at home' with UC and had substantial SM components. One trial 75 was excluded because all patients were seen in the ED then randomised to home compared with hospital (and therefore patients were not admitted at all unless in the control group). In the second study, 68 although patients were assessed in the ED, a substantial proportion of patients in both arms were initially admitted and then discharged from hospital.…”

Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit

“…This finding reinforces the hypothesis that hospitalization, leading to a loss of habitual benchmarks, itself represents an important and avoidable risk factor of falling. In elderly patients it is necessary to carefully evaluate the risk-tobenefit ratio before hospitalizing a subject, preferring a home based care setting (i.e., Home Hospitalization Services), whenever possible (Aimonino Ricauda et al, 2004, 2008.…”

Home management of hematological patients requiring hospital admission

“…Even though this study was not performed to analyze costs for management of hematological patients, the HHS has already demonstrated economical advantages over traditional care in the management of elderly patients affected by stroke or chronic obstructive pulmonary disease (Ricauda et al, 2005;Aimonino Ricauda et al, 2008). The home treatment of patients during the post-transplant pancytopenic phase has been found cheaper than in-hospital treatment (Svahn et al, 2002).…”

“…Medical consultation with other hospital specialists is possible in the hospital or at the patient's home. The HHS provides substitutive hospital-at-home care in a ''clinical unit'' model (Tibaldi et al, 2004;Ricauda et al, 2005;Aimonino Ricauda et al, 2008). Several examinations and treatments can be carried out at home, including blood tests, electrocardiogram, spirometry, pulse oximetry, ultrasonographic investigations such as echocardiograms and vascular Dopplerultrasonographies, placement of peripherally inserted central catheters, oxygen and other respiratory therapies, intravenous fluids and drugs, blood transfusions, surgical treatment of pressure ulcers.…”