title: Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients.
abstract: It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation. To this end, 222 COPD patients (3.2% female; 71+/-10 yrs (mean+/-SD)) were randomly assigned to HH (n=121) or conventional care (n=101). During HH, integrated care was delivered by a specialised nurse with the patient's free-phone access to the nurse ensured for an 8-week follow-up period. Mortality (HH: 4.1%; controls: 6.9%) and hospital readmissions (HH: 0.24+/-0.57 controls: 0.38+/-0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13+/-0.43 versus 0.31+/-0.62); and 2) a noticeable improvement of quality of life (delta St George's Respiratory Questionnaire (SGRQ), -6.9 versus -2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient's satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7+/-2.3 versus 4.2+/-4.1 days). A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.
authors.affiliation: Servei de Pneumologia (ICPCT), Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Hernandez
authors.forename: A
authors.initials: A
authors.lastname: Casas
authors.forename: J
authors.initials: J
authors.lastname: Escarrabill
authors.forename: J
authors.initials: J
authors.lastname: Alonso
authors.forename: J
authors.initials: J
authors.lastname: Puig-Junoy
authors.forename: E
authors.initials: E
authors.lastname: Farrero
authors.forename: G
authors.initials: G
authors.lastname: Vilagut
authors.forename: B
authors.initials: B
authors.lastname: Collvinent
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez-Roisin
authors.forename: J
authors.initials: J
authors.lastname: Roca
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D013997:Time Factors