Home Care NetWork
Home Care Literature Review: January– June 2006
Home Care and Pneumonia:
Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med 2005; 143:798-808
This prospective quasi experimental case series evaluated the outcomes of a hospital-at-home model compared with hospital admission at three Medicare-managed care (Medicare + Choice) health systems and a Veterans Administration medical center in 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of COPD, or cellulitis. In two of three sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs 4.9 days) (p = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care ($5081 vs $7480) (p <0.001). There was no difference in quality of care at either site of care. This important study demonstrates the feasibility and acceptability of in-home care for respiratory and other conditions is generally followed as requiring hospitalization. While it is still not large enough to be considered definitive, it supplies strong support for the hospital-at-home concept. What is really needed now is a large-scale national trial.
Richards DA, Toop LJ, Epton MJ, et al. Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial. Med J Aust 2005; 183:235-238
This randomized clinical trial from New Zealand compared outcomes in 55 patients with mild to moderately severe community-acquired pneumonia seen in the emergency department of a single hospital The patients were then treated either at home by a primary care team or were hospitalized for usual care. The median number of days to discharge from care was higher in the home care group (4 days; range, 1-14) than in the hospital groups (2 days; range, 0-10; p = 0.004), but there was no difference in the number of days on IV antibiotics or on subsequent oral antibiotics; patient-rated symptom scores at 2 and 6 weeks; median change in symptom severity from baseline to 6 weeks; and general functioning at 2 and 6 weeks. Patients in both groups were satisfied with their treatment, with a clear preference for community treatment (p <0.001). This small study endorses in-home treatment of appropriate patients with community-acquired pneumonia.
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