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Question Is “hospital at home” (HaH) care as effective and cost effective as inpatient hospital care for older adults?
Randomised controlled trial (RCT) with 3 months follow up.
A district general hospital and its catchment area (102 general practitioners [GPs] in 26 practices) in Northampton, UK.
Adults who had hip replacements (n=86), knee replacements (n=86), hysterectomies (n=238), chronic obstructive airways disease (COPD) (n=32), or who were elderly medical patients (n=96). Exclusion criteria were age <60 years (except for women having a hysterectomy), hysterectomy for malignancies, and an unsuitable home situation.
After randomisation, the HaH group had 37 patients with hip replacement, 47 with knee replacement, 114 with hysterectomy, 15 with COPD, and 50 who were elderly medical patients. The hospital group had 49 patients with hip replacement, 39 with knee replacement, 124 with hysterectomy, 17 with COPD, and 46 who were elderly medical patients. HaH care included nursing, physiotherapy, occupational therapy, pathology, speech therapy, and GP care at home, with discharge decisions made by the senior nurse. Hospital patients received usual care.
Main outcome and cost measures
General health including quality of life; physical function; symptoms; hospital readmission; mortality; patient and caregiver preferred form of care; and hospital, HaH, GP, patient and family, and total costs.
For hip replacement (follow up 94%), patients who …
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