title: Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial.
abstract: BACKGROUND
  In the absence of clear differences in effectiveness and cost-effectiveness between hospital-at-home schemes and usual hospital care, patient preference plays an important role. This study investigates patient preference for treatment place, associated factors and patient satisfaction with a community-based hospital-at-home scheme for COPD exacerbations.
  
  
  METHODS
  The study is part of a larger randomised controlled trial. Patients were randomised to usual hospital care or early assisted discharge which incorporated discharge at day 4 and visits by a home care nurse until day 7 of treatment (T+4 days). The hospital care group received care as usual and was discharged from hospital at day 7. Patients were followed for 90 days (T+90 days). Patient preference for treatment place and patient satisfaction (overall and per item) were assessed quantitatively and qualitatively using questionnaires at T+4 days and T+90 days. Factors associated with patient preference were analysed in the early assisted discharge group.
  
  
  RESULTS
  139 patients were randomised. No difference was found in overall satisfaction. At T+4 days, patients in the early assisted discharge group were less satisfied with care at night and were less able to resume normal daily activities. At T+90 days there were no differences for the separate items. Patient preference for home treatment at T+4 days was 42% in the hospital care group and 86% in the early assisted discharge group and 35% and 59% at T+90 days. Patients' mental state was associated with preference.
  
  
  CONCLUSIONS
  Results support the wider implementation of early assisted discharge for COPD exacerbations and this treatment option should be offered to selected patients that prefer home treatment.
authors.affiliation: Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands; Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. Electronic address: cecileutens@gmail.com.
authors.forename: Cecile M A
authors.initials: CM
authors.lastname: Utens
authors.forename: Lucas M A
authors.initials: LM
authors.lastname: Goossens
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
authors.forename: Walter
authors.initials: W
authors.lastname: van Litsenburg
authors.forename: Annet
authors.initials: A
authors.lastname: Janssen
authors.forename: Anouschka
authors.initials: A
authors.lastname: van der Pouw
authors.forename: Frank W J M
authors.initials: FW
authors.lastname: Smeenk
mesh_terms: D000368:Aged; D004644:Emotions; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012944:Social Support
keywords: Chronic Obstructive Pulmonary Disease; Early assisted discharge; Hospital-at-home; Patient preference; Patient satisfaction