The Feasibility of Home Treatment instead of Hospitalization for Older Patients with Acute Illness

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The summary below is from the full report titled "Hospital at Home: Feasibility and Outcomes of a Program To Provide Hospital-Level Care at Home for Acutely Ill Older Patients." It is in the 6 December 2005 issue of Annals of Internal Medicine (volume 143, pages 798-808). The authors are B. Leff, L. Burton, S.L. Mader, B. Naughton, J. Burl, S.K. Inouye, W.B. Greenough III, S. Guido, C. Langston, K.D. Frick, D. Steinwachs, and J.R. Burton.

What is the problem and what is known about it so far?

Hospitals are the usual location for the treatment of older patients with acute illnesses, such as pneumonia (lung infection), congestive heart failure (fluid in the lungs caused by problems with the heart's pumping ability), chronic obstructive pulmonary disease (lung disease often attributable to smoking), and cellulitis (skin infection). However, older patients who are hospitalized often experience complications of treatment, confusion, weakness, and loss of ability to care for themselves. Some small, preliminary studies suggest that it is possible to provide hospital-like care for these conditions in patients' homes. However, most previous studies used models of care more similar to typical skilled care services than to hospital care and were performed in countries with national health insurance.

Why did the researchers do this particular study?

To determine whether it was feasible to provide hospital-level care in patients' homes for older patients who would typically be hospitalized.

Who was studied?

355 patients who lived in their own homes but presented to 1 of 3 centers with pneumonia, congestive heart failure, chronic obstructive pulmonary disease, or cellulitis that physicians believed required hospitalization. To be eligible for the study, patients had to be 65 years of age or older, live in a certain area, and not have low blood oxygen, signs of heart attack, or multiple conditions requiring hospitalization.

How was the study done?

The study included two 11-month phases. During the first phase, eligible patients were hospitalized in the usual manner. During the second phase, the researchers offered eligible patients the option of receiving hospital-level care at home rather than in the hospital. Patients who chose hospital at home received treatment in their homes. Home treatment involved 8 to 24 hours of nursing care immediately after entry into the program and daily visits from a nurse and a physician. Patients received drugs, oxygen, laboratory tests, and other therapy at home as needed. Doctors and nurses were available 24 hours a day for urgent visits. The researchers compared the outcomes and costs of hospitalized patients with those of patients who received hospital-level care at home.

What did the researchers find?

Patients chose home treatment 69% of the time in 2 centers and 29% of the time in the third center. Patients treated at home had fewer procedures, similar quality of care, shorter treatment stays, and lower costs than those who were hospitalized. The results also suggested that they had fewer complications of treatment.

What were the limitations of the study?

Patients who chose home care might have been healthier or might have had stronger social support than those who did not choose this type of care.

What are the implications of the study?

Hospital-like care at home seems to be a feasible option for older patients with certain acute medical problems. This model of care deserves additional study.