A system employing hospital levels of care delivered at home to elderly patients with chronic obstructive pulmonary disease (COPD) exacerbations provides results superior to those with inpatient treatment, according to Italian and US researchers.
"Acute hospital-level care in the patient's home," investigator Dr. Vittoria Tibaldi told Reuters Health, "can provide safe and effective treatment of the exacerbations of this condition, reduce the hospital readmission rates, improve patient's quality of life and reduce caregiver stress."
Dr. Tibaldi of San Giovanni Battista Hospital, Turin and colleagues note that "hospital-at-home" approaches have shown some success but the effect on outcome is unclear.
The researchers therefore studied 104 patients, mean age 80 years, hospitalized because of acute COPD exacerbation. The patients were then randomized to treatment in a general medical ward or to a physician-led geriatric home hospitalization service.
Follow-up at 6 months showed that only 42% of the home patients required hospital readmission, significantly fewer than the 87% of those treated as inpatients. The time to readmission was also longer (78 versus 37 days, respectively).
However, home group patients who were readmitted had a longer hospital stay (15.5 versus 11.0 days), the authors report in the March issue of The Journal of the American Geriatric Society.
Home-based patients also had significantly greater improvements in depression and quality-of-life scores than did the acute hospital group. In addition, expenditures appeared to be about $50 per day lower in the home-care patients.
"To achieve such results," Dr. Tibaldi concluded, "several conditions are needed, in particular a confident and close hospital-at-home staff, a tight link with the hospital facilities and the selection of patients having adequate support at home."
J Am Geriatr Soc 2008;56:493-500.
Reviewed by Dr. Ramaz Mitaishvili
