Early discharge to a hospital at home scheme yielded similar mortality and quality of life as routine care, but routine care length of stay was 62% (95% CI 51-75%) of the hospital at home scheme.
RCT (n=241)
Does early discharge to a hospital at home scheme improve quality of life, satisfaction, physical functioning, or mortality compared to routine hospital care in medically stable elderly patients?
Early discharge to a hospital at home scheme is an acceptable and equally effective alternative to routine hospital care for medically stable elderly patients.
Effect estimate: 62% (95% CI 51-75)
Abstract Objective: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. Design: Pragmatic randomised controlled trial. Setting: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate. Interventions: Patients' received hospital at home care or routine hospital care. Main outcome measures: Patients' quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months. Results: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme. Conclusions: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services. Key messages Pressure on hospital beds, the increasing age of the population, and high costs associated with acute hospital care have fuelled the search for alternatives to inpatient hospital care There were no significant differences between early discharge to hospital at home scheme and routine hospital care in terms of patient quality of life, physical functioning, and most measures of patient satisfaction Length of stay for hospital patients was significantly shorter than that of hospital at home patients, but, owing to qualitative differences between the two interventions, this does not necessarily mean differences in effectiveness Early discharge to hospital at home provides an acceptable alternative to routine hospital care in terms of effectiveness and patient acceptability
Richards et al. (Sat,) conducted a rct in Medically stable elderly patients (n=241). Early discharge to a hospital at home scheme vs. Routine hospital care was evaluated on Quality of life, satisfaction, physical functioning, length of stay, and mortality at 3 months (62%, 95% CI 51-75). Early discharge to a hospital at home scheme yielded similar mortality and quality of life as routine care, but routine care length of stay was 62% (95% CI 51-75%) of the hospital at home scheme.