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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
Author(s) -
Aimonino Ricauda Nicoletta,
Tibaldi Vittoria,
Leff Bruce,
Scarafiotti Carla,
Marinello Renata,
Zanocchi Mauro,
Molaschi Mario
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01562.x
Subject(s) - medicine , exacerbation , copd , quality of life (healthcare) , randomized controlled trial , depression (economics) , prospective cohort study , emergency medicine , physical therapy , nursing , economics , macroeconomics
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.