Home Care NetWork
Home Care Literature Reviews 2004
Cardiovascular Surgery:
Fritzsche D, Eitz T, Grimmig O, Brensing A, Minami K, Korfer R. Home monitoring of patients after prosthetic valve surgery – experimental background and first clinical attempts. Thorac Cardiovasc Surg. 2004;52:211-7.
This German case series evaluated the in-home use of an echocardiograph/acoustical recorder and internet data transmission in animal models and in 30 patients following mechanical valve replacement. All patients regularly recorded and passed on their signals. Surveys revealed high acceptance and easy handling of the devices. This is really a feasibility study but is encouraging that this technology may be an effective alternative to clinic visits.
Cano NJ, Pichard C, Roth H, Court-Fortune I, Cynober L, Gerard-Boncompain M, Cuvelier A, Laaban JP, Melchior JC, Raphael JC, Pison CM; Clinical Research Group of the Societe Francophone de Nutrition Enterale et Parenterale. C -reactive protein and body mass index predict outcome in end-stage respiratory failure. Chest. 2004;126:540-6.
This French prospective, multicenter cohort study of factors associated with hospitalization and survival in 446 patients with stable chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation found 1.8 +/- 1.7 hospitalizations per year involving 57% of patients. Independent predictors of hospitalization were oral corticosteroids, FEV1, and plasma C-reactive protein. One-year and 2-year cumulative survivals were 93% and 69%, respectively. Plasma C-reactive protein, BMI, Pao2 on room air, and oral corticosteroids independently predicted survival in multivariate analysis. Nutrition and nutritional parameters were as useful as physiological measures in this study.
Kwok T, Lum CM, Chan HS, Ma HM, Lee D, Woo J. A randomized, controlled trial of an intensive community nurse-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease. J Am Geriatr Soc. 2004;52:1240-6.
This randomized, controlled trial compared the effect of an intensive community nurse (CN)-supported discharge program with usual care in preventing hospital readmissions of 157 older patients with chronic lung disease (CLD) discharged from two acute hospitals in the same health region in Hong Kong. The CNs performed case management including home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. Subjects had telephone access to CNs during normal working hours from There was no difference between the CN and control groups with the CN group suffering a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, p=0.080, chi2 test). This finding is at odds with older, European studies evaluating home hospital approaches to COPD exacerbations but this appears to be a more diverse group of patients with a less structured program. There was no evaluation of cost in this study – too bad (see below).
Ram FS, Wedzicha JA, Wright J, Greenstone M. Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence. BMJ. 2004;329:315. Epub 2004 Jul 08.
This systematic review of randomised controlled trials evaluated the efficacy of hospital at home schemes compared with inpatient care in terms of mortality and readmission to hospital in seven trials with 754 patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). While readmission and mortality were not significantly different (relative risk 0.89, 95% confidence interval 0.72 to 1.12, and 0.61, 0.36 to 1.05, respectively), hospital at home programs had substantial cost. This analysis is a bit more encouraging but makes the point that the medical outcomes may be similar. This isn't so bad as the hospital represents the gold standard. If home based programs are as good (i.e., not different) and cheaper- go for it!
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