Performance of hospital-at-home after a randomised controlled trial.
OBJECTIVE
To compare the performance of an admission-avoidance hospital-at-home scheme one year after the end of a randomised trial with its performance during the trial.


METHODS
Observational study of patients admitted to the scheme during a period of 12-19 months after the trial ended. In addition to routine data from service records, patients were interviewed at three days, two weeks and three months after admission, using the same instruments as used in the trial.


RESULTS
All 78 patients admitted to hospital-at-home during the follow-up period were included, and compared with the 95 patients admitted during the trial. The referral rate to hospital-at-home was the same (11 per month) as during the trial. During the trial, patients were randomised to hospital-at-home or hospital, meaning that hospital-at-home worked at about double the trial volume in the post-trial period. Baseline characteristics showed no statistically significant differences except that post-trial patients were less cognitively impaired. There were no statistically significant differences between the groups in survival at two weeks and three months, or in Barthel index, Sickness Impact Profile 68 and Philadelphia Geriatric Morale Scale. Length of stay in hospital-at-home was significantly shorter in the post-trial period (median of five days versus seven, P < 0.001), and more patients received a visit from their general practitioner during the period of admission (54% versus 38%, P = 0.04); otherwise there were no significant differences in process measures.


CONCLUSIONS
Apart from working at higher volume and achieving a shorter length of stay, performance of the hospital-at-home scheme a year after the trial ended was little different from that reported during the trial. This is an example of an observational study providing evidence to support the generalisability of trial findings.
Wilson
Andrew
A
Department of General Practice & Primary Health Care, University of Leicester, Leicester, UK.
Parker
Hilda
H
Wynn
Alison
A
Spiers
Nicky
N
D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D018575:Home Care Services, Hospital-Based / Q000592:standards* / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010343:Patient Admission; D010359:Patient Readmission; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D016526:Workload