Medical model for hospital in the home: effects on patient management.
OBJECTIVE
To evaluate the effects of a change to a medical model for hospital in the home (HITH).


METHODS
This was a retrospective pre- and post-intervention study in the Royal Melbourne Hospital HITH between 28 March 2002 and 29 March 2006. The intervention was daily review, by medical staff, of all patients in their homes. 159 patients with cellulitis or deep venous thrombosis (DVT) admitted to HITH in the pre-intervention period were matched with patients admitted in the post-intervention period.


METHODS
HITH length of stay (LOS), scheduled and unscheduled hospital review rates (during the HITH admission), and hospital admission rates.


RESULTS
Post-intervention, median LOS decreased (6 v 5 days [P = 0.03]). There were also significant reductions in scheduled and unscheduled review rates (40.9 v 1.3 reviews/100 patients [P < 0.001] and 15.7 v 4.4 reviews/100 patients [P = 0.001], respectively) and hospital admission rates (10.7 v 3.8 admissions/100 patients [P = 0.02]). Although there was no difference in adverse event rates between the two periods (3.1 v 2.5/100 patients [P = 0.50]), there was a significantly greater complication rate post-intervention (57.2 v 92.4/100 patients [P < 0.001]).


CONCLUSIONS
The medical model resulted in significant improvements in process measures and clinical endpoints among patients with cellulitis and DVT.
Tran
Anh
A
Emergency Department, Werribee Mercy Hospital, Werribee, VIC, Australia.
Taylor
David McD
DM
D000328:Adult; D000368:Aged; D002481:Cellulitis / Q000188:drug therapy; D005260:Female; D006699:Home Care Services; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010346:Patient Care Management; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000628:therapy; D014739:Victoria