Compared with hospitalization, home care was associated with similar mortality and lower costs.
Hospitalization of older patients often leads to declines in functional status and high likelihood of rehospitalization. Researchers in Italy assessed the effectiveness of a physician-led home-hospitalization program for 101 patients (mean age, 81) who presented to an emergency department with acutely decompensated NYHA class III or IV heart failure.
Patients were randomized to home care or hospital care. At-home patients received care from a team that included physicians, nurses, physical therapists, social workers, and counselors. The team performed blood testing, echocardiography, arterial blood gas monitoring, blood transfusions, and central venous access, among other interventions. At 6 months, mortality was 15% in both groups; readmission rates were lower among at-home patients than among hospitalized patients (17% vs. 34%); and at-home patients showed significantly greater mean improvements from baseline in depression, nutritional status, and quality-of-life scores. No at-home patients and 16% of hospitalized patients were institutionalized after their initial assignment.
Comment: This small but intriguing study showed that elders with acute heart failure could be cared for safely at home. Although costs are difficult to translate across countries, home hospitalization was less costly in this study. However, as editorialists note, the current Medicare reimbursement system would not accommodate this type of management strategy in the U.S.
Published in Journal Watch General Medicine October 13, 2009
Citation(s):
Tibaldi V et al. Hospital at home for elderly patients with acute decompensation of chronic heart failure: A prospective randomized controlled trial. Arch Intern Med 2009 Sep 28; 169:1569. (http://dx.doi.org/10.1001/archinternmed.2009.267)
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- Medline abstract (Free)
Kao H and Walter LC. Improvement of hospital care of elderly patients: Thinking outside the (hospital) box. Arch Intern Med 2009 Sep 28; 169:1576. (http://dx.doi.org/10.1001/archinternmed.2009.268)
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- Medline abstract (Free)
Source : http://general-medicine.jwatch.org/cgi/content/full/2009/1013/3