title: Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care.
abstract: OBJECTIVE
  To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.
  
  
  METHODS
  Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.
  
  
  METHODS
  Three Medicare managed care health systems and a Veterans Affairs Medical Center.
  
  
  METHODS
  Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.
  
  
  METHODS
  Treatment in a substitutive HaH model.
  
  
  METHODS
  Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.
  
  
  RESULTS
  The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean +/- standard deviation 1.7 +/- 1.8 vs 4.3 +/- 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05-0.30).
  
  
  CONCLUSIONS
  HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21224, USA. bleff@jhmi.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Lynda
authors.initials: L
authors.lastname: Burton
authors.forename: Scott L
authors.initials: SL
authors.lastname: Mader
authors.forename: Bruce
authors.initials: B
authors.lastname: Naughton
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Burl
authors.forename: Debbie
authors.initials: D
authors.lastname: Koehn
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clark
authors.forename: William B
authors.initials: WB
authors.lastname: Greenough
authors.forename: Susan
authors.initials: S
authors.lastname: Guido
authors.forename: Donald
authors.initials: D
authors.lastname: Steinwachs
authors.forename: John R
authors.initials: JR
authors.lastname: Burton
mesh_terms: D000368:Aged; D002481:Cellulitis / Q000628:therapy; D017714:Community-Acquired Infections / Q000628:therapy; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged; D006333:Heart Failure / Q000628:therapy; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D018410:Pneumonia, Bacterial / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States