Prospective evaluation of clinical criteria to select older persons with acute medical illness for care in a hypothetical home hospital.
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.
Leff
B
B
Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Burton
L
L
Bynum
J W
JW
Harper
M
M
Greenough
W B
WB
Steinwachs
D
D
Burton
J R
JR
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