title: Prospective evaluation of clinical criteria to select older persons with acute medical illness for care in a hypothetical home hospital.
abstract: OBJECTIVE
  To evaluate criteria to select older persons who need hospitalization for common acute medical illnesses for care in a hypothetical home hospital.
  
  
  METHODS
  Prospective record review.
  
  
  METHODS
  Patients aged 65 and older admitted to the general medical service of a community-based university hospital.
  
  
  METHODS
  We developed illness-specific selection criteria to identify older persons with certain acute medical conditions for treatment in a hypothetical home hospital. The selection criteria were reviewed prospectively against all community-dwelling older patients admitted to the general medical service of a community-based university hospital over a 2-month period. We determined eligibility for home hospital admission based on information available at the time of admission and then tracked the patient's hospital course.
  
  
  RESULTS
  One hundred fifty-seven admissions of 143 patients were reviewed. The selection criteria identified 33% of patients admitted to the acute hospital with one of the three target diagnoses as eligible for a home hospital model of care had it been available. Eligible patients experienced shorter lengths of stay (3.7 vs 5.4 days, P = .012), fewer mean number of procedures performed (0.98 vs 1.70, P = .001), fewer mean number of complications (0.17 vs 0.56, P = .010), and fewer events that could be handled only in the acute hospital setting (P = .036). In addition, in logistic regression analysis, three criteria for home hospital ineligibility, pulmonary congestion associated with ischemic chest pain (odds ratio 6.85, 95% CI 2.64, 17.81), the presence of an acute coexisting illness requiring hospitalization independent of the target conditions (odds ratio 2.66, 95% CI 1.11, 6.41), and significant pulmonary congestion after initial treatment (odds ratio 14.4, 95% CI 1.77, 117.41) were significantly associated with items difficult to accomplish at home.
  
  
  CONCLUSIONS
  Criteria can be delineated that identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital.
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
authors.forename: B
authors.initials: B
authors.lastname: Leff
authors.forename: L
authors.initials: L
authors.lastname: Burton
authors.forename: J W
authors.initials: JW
authors.lastname: Bynum
authors.forename: M
authors.initials: M
authors.lastname: Harper
authors.forename: W B
authors.initials: WB
authors.lastname: Greenough
authors.forename: D
authors.initials: D
authors.lastname: Steinwachs
authors.forename: J R
authors.initials: JR
authors.lastname: Burton
mesh_terms: D000208:Acute Disease / Q000145:classification*; D000368:Aged; D003953:Diagnosis-Related Groups; D004608:Eligibility Determination / Q000379:methods*; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D015203:Reproducibility of Results