title: A mixed method study to compare use and experience of hospital care and a nurse-led acute respiratory assessment service offering home care to people with an acute exacerbation of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Over the past 10 years hospital at home schemes for the treatment of an acute exacerbation of Chronic Obstructive Pulmonary Disease have proliferated throughout developed countries. For selected patients treatment at home is no less advantageous in terms of readmission rates and length of stay than treatment in hospital. Although care at home might seem to be a more desirable option than admission to hospital, little is known about care preferences and how people exercise service choice.
  
  
  OBJECTIVE
  1. to determine patients' recent use of and satisfaction with health care services during exacerbations of Chronic Obstructive Pulmonary Disease. 2. To determine and compare patients' and families' perceived future care preferences. 3. To complete an in-depth exploration of care experiences and preferences with a subset of respondents and their families.
  
  
  METHODS
  A mixed method design was used consisting of a postal survey and in-depth qualitative interviews with a subset of questionnaire respondents.
  
  
  METHODS
  An outreach service provided by a large university hospital within Scotland, UK.
  
  
  METHODS
  One hundred and four out-patients registered with the Acute Respiratory Assessment Service and who had experienced hospital inpatient care during the past year, and their families. A subset of respondents was invited to take part in qualitative interviews.
  
  
  RESULTS
  The majority of respondents indicated a preference for the home care service, and this was positively associated with high coping skills. There was a strong relationship between personal and family preferences. There was no linear relationship between a clinical measure of severity of lung disease and service use or care preferences. Results from the qualitative interviews endorsed and explained these findings.
  
  
  CONCLUSIONS
  A range of factors combined to influence service use at a particular point in time, implying a need for increased self-management support from nurses and increased service provision.
authors.affiliation: Department of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, UK. I.Schofield@gcal.ac.uk
authors.forename: Irene
authors.initials: I
authors.lastname: Schofield
authors.forename: Christina
authors.initials: C
authors.lastname: Knussen
authors.forename: Debbie
authors.initials: D
authors.lastname: Tolson
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000458:organization & administration*; D003159:Community-Institutional Relations; D005190:Family / Q000523:psychology; D005260:Female; D019538:Health Care Surveys; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D010343:Patient Admission; D017060:Patient Satisfaction; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing / Q000523:psychology; D036301:Qualitative Research; D012107:Research Design; D012606:Scotland; D011795:Surveys and Questionnaires