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Hospital in the home: a randomised controlled trial
Author(s) -
Caplan Gideon A,
Ward John A,
Brennan Nicholas J,
Coconis Janis,
Board Neville,
Brown Ann
Publication year - 1999
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1999.tb127711.x
Subject(s) - medicine , constipation , urinary incontinence , adverse effect , referral , incidence (geometry) , psychological intervention , patient satisfaction , tertiary referral hospital , randomized controlled trial , pediatrics , emergency medicine , surgery , retrospective cohort study , family medicine , nursing , physics , optics
Objectives To compare treatment of acute illness at home and in hospital, assessing safety, effect on geriatric complications, and patient/carer satisfaction. Design Randomised controlled trial. Setting A tertiary referral hospital affiliated with the University of New South Wales. Participants 100 patients (69% older than 65 years) with a variety of acute conditions, who were assessed in the emergency department as requiring admission to hospital. Interventions Patients were allocated at random to be treated by a hospital‐in‐the‐ home (HIH) service in their usual residence or to be admitted to hospital. Main outcome measures Geriatric complications (confusion, falls, urinary incontinence or retention, faecal incontinence or constipation, phlebitis and pressure areas), patient/carer satisfaction, adverse events, and death. Results There was a lower incidence of confusion (0 v. 20.4% [95% Cl, 9.1%–31.7%); P= 0.0005), urinary complications (incontinence or retention) (2.0% [95% Cl, –1.8%, 5.8%) v. 16.3% [95% Cl, 6.0%, 26.6%); P=0.01), and bowel complications (incontinence or constipation) (0 v. 22.5% [95% Cl, 10.7%, 34.1%); P=0.0003) among HIH‐treated patients. No significant difference in number of adverse events and deaths (to 28 days after discharge) in the two groups was found (although numbers were small). Patient and carer satisfaction was significantly higher in the HIH group. Conclusions Home treatment appears to provide a safe alternative to hospitalisation for selected patients, and may be preferable for some older patients. We found high levels of both patient and carer satisfaction with home treatment.