Substitutive hospital-at-home care for elderly patients with acute COPD exacerbations significantly reduced hospital readmissions at 6 months compared to inpatient care (42% vs 87%, P<.001).
RCT (n=104)
Single-blind
randomly assigned
No
Does physician-led substitutive hospital-at-home care reduce hospital readmission rates and mortality in elderly patients with acute exacerbations of COPD?
Physician-led hospital-at-home care for elderly patients with COPD exacerbations significantly reduces 6-month hospital readmissions and healthcare costs while improving quality of life compared to standard inpatient care.
Absolute Event Rate: 42% vs 87%
p-value: p=<.001
OBJECTIVES: To evaluate hospital readmission rates and mortality at 6-month follow-up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN: Prospective randomized, controlled, single-blind trial with 6-month follow-up. SETTING: San Giovanni Battista Hospital of Torino. PARTICIPANTS: One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were randomly assigned to a general medical ward (GMW, n=52) or to a geriatric home hospitalization service (GHHS, n=52). MEASUREMENTS: Measurements of baseline sociodemographic information; clinical data; functional, cognitive, and nutritional status; depression; and quality of life were obtained. RESULTS: There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6-month follow-up (42% vs 87%, P<. 001). Cumulative mortality at 6 months was 20. 2% in the total sample, without significant differences between the two study groups. Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW (15. 5+/-9. 5 vs 11. 0+/-7. 9 days, P=. 010). Only GHHS patients experienced improvements in depression and quality-of-life scores. On a cost per patient per day basis, GHHS costs were lower than costs in GMW (101. 4+/-61. 3 vs 151. 7+/-96. 4, P=. 002). CONCLUSION: 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.
Ricauda et al. (Fri,) conducted a rct in Acute exacerbation of chronic obstructive pulmonary disease (COPD) (n=104). Geriatric home hospitalization service (GHHS) vs. General medical ward (GMW) was evaluated on Hospital readmission at 6 months (p=<.001). Substitutive hospital-at-home care for elderly patients with acute COPD exacerbations significantly reduced hospital readmissions at 6 months compared to inpatient care (42% vs 87%, P<.001).