title: Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate hospital readmission rates and mortality at 6-month follow-up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Prospective randomized, controlled, single-blind trial with 6-month follow-up.
  
  
  METHODS
  San Giovanni Battista Hospital of Torino.
  
  
  METHODS
  One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were randomly assigned to a general medical ward (GMW, n=52) or to a geriatric home hospitalization service (GHHS, n=52).
  
  
  METHODS
  Measurements of baseline sociodemographic information; clinical data; functional, cognitive, and nutritional status; depression; and quality of life were obtained.
  
  
  RESULTS
  There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6-month follow-up (42% vs 87%, P<.001). Cumulative mortality at 6 months was 20.2% in the total sample, without significant differences between the two study groups. Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW (15.5+/-9.5 vs 11.0+/-7.9 days, P=.010). Only GHHS patients experienced improvements in depression and quality-of-life scores. On a cost per patient per day basis, GHHS costs were lower than costs in GMW ($101.4+/-61.3 vs $151.7+/-96.4, P=.002).
  
  
  CONCLUSIONS
  Physician-led substitutive hospital-at-home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months, lower healthcare costs, and better quality of life.
authors.affiliation: Department of Medical and Surgical Disciplines, Geriatric Section, S. Giovanni Battista Hospital, University of Torino, Torino, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Aimonino Ricauda
authors.forename: Vittoria
authors.initials: V
authors.lastname: Tibaldi
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Carla
authors.initials: C
authors.lastname: Scarafiotti
authors.forename: Renata
authors.initials: R
authors.lastname: Marinello
authors.forename: Mauro
authors.initials: M
authors.lastname: Zanocchi
authors.forename: Mario
authors.initials: M
authors.lastname: Molaschi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000458:organization & administration*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome