Home Care NetWork
Home Care Literature Review: July - December 2006
Home-Based Disease Management Programs:
Pearson S, Inglis SC, McLennan SN, Brennan L, Russell M, Wilkinson D, Thompson
DR, Stewart S. Prolonged effects of a home-based intervention in patients with chronic illness. Arch Intern Med 2006; 166:645-650
This Australian randomized clinical trial compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of 260 patients with chronic illness initially exposed to a nondisease-specific, multidisciplinary, home-based intervention (HBI) or to usual postdischarge care (n = 268). They reported that HBI had no impact on all-cause mortality (relative risk, 1.04; 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86-1.24) and only a marginal impact in reducing unplanned hospitalization (677 readmissions vs 824 for the usual care group, mean +/- SD rate, 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions/patient per year; p = .08). But if HBI patients with COPD were excluded, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without COPD (mean +/- SD rate, 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission/patient per year; p = .04) and by 21% in all surviving patients within 3 to 8 years (mean +/- SD rate, 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions/patient per year; p = .03). I suspect that the poor outcomes on COPD had more to do with the specific program than the disease itself. This interesting paper should be read by all those interested in home-based chronic disease management programs.
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