Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial
Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial
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DOI：
10.1007/s11606-018-4307-z
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发表时间：
2018-05-01
影响因子：
5.7
通讯作者：
Schnipper, Jeffrey L.
中科院分区：
文献类型：
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作者：
Levine, David M.;Ouchi, Kei;Schnipper, Jeffrey L.
医院是急性疾病的标准治疗，但医院可能不安全，不舒服，而且昂贵。在患者家中提供替代性医院级护理可能会降低成本，同时保持或改善质量、安全性和患者体验，尽管缺乏来自美国随机对照试验的证据。确定家庭医院护理是否在保持质量、安全性和患者体验的同时降低成本。随机对照试验。通过急诊科入院的任何感染或心力衰竭加重的成人，慢性阻塞性肺疾病或哮喘。家庭医院护理，包括护士和医生家访、静脉给药、持续监测、视频通信和床旁检测。主要结局是急性护理事件的直接费用。次要结果包括利用率，30天的费用，体力活动，和病人的经验。9名患者被随机分配到家里，11名常规护理。家庭患者急性护理事件的直接费用中位数比对照组患者低52%（IQR，28%; p = 0.05）。在护理期间，家庭患者的实验室订单较少（每次入院的中位数：6 vs. 19; p < 0.01），接受咨询的频率较低（0% vs. 27%; p = 0.04）。在家的患者身体活动更多（中位数分钟，209对78; p < 0.01），睡眠时间更长。家庭患者未发生不良事件，对照患者发生一起不良事件。对于家庭患者，急性护理加出院后30天的直接费用中位数低67%（IQR，77%; p < 0.01），家庭护理服务的使用率降低（22% vs. 55%; p = 0.08），再入院率降低（11% vs. 36%; p = 0.32）。两组患者的经验相似，与住院常规护理相比，使用替代家庭住院治疗降低了成本和利用率，并改善了体力活动。在质量、安全性和患者体验方面没有显著差异，更明确的结果有待更大规模的试验。
Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience.Randomized controlled trial.Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma.Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing.Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience.Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p < 0.01) and less often received consultations (0% vs. 27%; p = 0.04). Home patients were more physically active (median minutes, 209 vs. 78; p < 0.01), with a trend toward more sleep. No adverse events occurred in home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p < 0.01) lower, with trends toward less use of home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups.The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial.Trial Registration NCT02864420.