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“Hospital at home” care was as effective as routine hospital care for older adults

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 Question Is “hospital at home” (HaH) care as effective and cost effective as inpatient hospital care for medically stable elderly patients?

Design

Randomised controlled trial (RCT) with 3 months follow up.

Setting

Hospital wards and their catchment areas in Bristol, UK.

Patients

241 of 383 older adults (median age 79 y, 69% women) who were in hospital and medically stable. Inclusion criteria were availability of staff, expected positive rehabilitation, need for further hospital care if a HaH programme was not available, suitable home situation, agreement from the general practitioner (GP), and expected hospital stay of 1–28 days. Exclusion criterion was waiting for nursing home placement.

Intervention

After stratifying for type of admission (elective or emergency), randomisation was done to achieve twice as many patients in the HaH group. 160 patients allocated to the HaH group were discharged when they could be managed using routinely available community services. They received healthcare services between 8:30 am and 11:00 pm, or as needed. Minimal domestic services were provided. Staff included a district nurse coordinator, a registered nurse, a physiotherapist, an occupational therapist and technician, and support workers. 81 patients received usual hospital care. Follow up was 86%.

Main outcome and cost measures

Mortality; physical function; quality of life; patient satisfaction; length of care; and costs for …

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