Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care.
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.
Leff
Bruce
B
Department of Medicine, Division of Geriatric Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21224, USA. bleff@jhmi.edu
Burton
Lynda
L
Mader
Scott L
SL
Naughton
Bruce
B
Burl
Jeffrey
J
Koehn
Debbie
D
Clark
Rebecca
R
Greenough
William B
WB
Guido
Susan
S
Steinwachs
Donald
D
Burton
John R
JR
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