Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care.
OBJECTIVE
To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital.


METHODS
Pragmatic randomised controlled trial.


METHODS
Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people.


METHODS
241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate.


METHODS
Patients' received hospital at home care or routine hospital care.


METHODS
Patients' quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months.


RESULTS
There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme.


CONCLUSIONS
The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.
Richards
S H
SH
Department of Social Medicine, University of Bristol, Bristol BS8 2PR. suzanne.richards@bris.ac.uk
Coast
J
J
Gunnell
D J
DJ
Peters
T J
TJ
Pounsford
J
J
Darlow
M A
MA
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000592:standards / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018579:Patient Selection; D011788:Quality of Life; D014504:Urban Health