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Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial.
J Am Geriatr Soc 2008; 56(3):493-500JA

Abstract

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.

Authors+Show Affiliations

Department of Medical and Surgical Disciplines, Geriatric Section, S. Giovanni Battista Hospital, University of Torino, Torino, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18179503

Citation

Aimonino Ricauda, Nicoletta, et al. "Substitutive "hospital at Home" Versus Inpatient Care for Elderly Patients With Exacerbations of Chronic Obstructive Pulmonary Disease: a Prospective Randomized, Controlled Trial." Journal of the American Geriatrics Society, vol. 56, no. 3, 2008, pp. 493-500.
Aimonino Ricauda N, Tibaldi V, Leff B, et al. Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. J Am Geriatr Soc. 2008;56(3):493-500.
Aimonino Ricauda, N., Tibaldi, V., Leff, B., Scarafiotti, C., Marinello, R., Zanocchi, M., & Molaschi, M. (2008). Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. Journal of the American Geriatrics Society, 56(3), pp. 493-500. doi:10.1111/j.1532-5415.2007.01562.x.
Aimonino Ricauda N, et al. Substitutive "hospital at Home" Versus Inpatient Care for Elderly Patients With Exacerbations of Chronic Obstructive Pulmonary Disease: a Prospective Randomized, Controlled Trial. J Am Geriatr Soc. 2008;56(3):493-500. PubMed PMID: 18179503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. AU - Aimonino Ricauda,Nicoletta, AU - Tibaldi,Vittoria, AU - Leff,Bruce, AU - Scarafiotti,Carla, AU - Marinello,Renata, AU - Zanocchi,Mauro, AU - Molaschi,Mario, Y1 - 2008/01/04/ PY - 2008/1/9/pubmed PY - 2008/4/11/medline PY - 2008/1/9/entrez SP - 493 EP - 500 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 56 IS - 3 N2 - 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. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/18179503/Substitutive_"hospital_at_home"_versus_inpatient_care_for_elderly_patients_with_exacerbations_of_chronic_obstructive_pulmonary_disease:_a_prospective_randomized_controlled_trial_ L2 - https://doi.org/10.1111/j.1532-5415.2007.01562.x DB - PRIME DP - Unbound Medicine ER -