title: "Hospital at home" for neuromuscular disease patients with respiratory tract infection: a pilot study.
abstract: BACKGROUND
  The "hospital-at-home" model may provide adequate care without an adverse effect on clinical outcome, and is generally well received by users. Our objective was to compare hospital-at-home and in-patient hospital care for neuromuscular disease (NMD) patients with respiratory tract infections.
  
  
  METHODS
  We conducted a prospective randomized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000. We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment. Hospital-at-home was provided as an alternative to in-patient admission. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, and cost of patient care.
  
  
  RESULTS
  Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for hospital-at-home. Twenty-six subjects were randomized to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, P = .19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 d, P = .21), or mortality at 3 months (3/26 vs 4/27 deaths, P = .42) between the groups. Hospital-at-home failure was independently correlated with type of NMD (P = .004) with an odds ratio of failure of 17.3 (95% CI 2.1 to infinity) for subjects with amyotrophic lateral sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home, compared to the hospitalized individuals.
  
  
  CONCLUSIONS
  Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections.
authors.affiliation: Department of Respiratory Pathophysiology and the Intensive Care Unit, City Hospital of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vianello
authors.forename: Francesca
authors.initials: F
authors.lastname: Savoia
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pipitone
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nordio
authors.forename: Giulia
authors.initials: G
authors.lastname: Gallina
authors.forename: Luciana
authors.initials: L
authors.lastname: Paladini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Concas
authors.forename: Giovanna
authors.initials: G
authors.lastname: Arcaro
authors.forename: Federico
authors.initials: F
authors.lastname: Gallan
authors.forename: Elena
authors.initials: E
authors.lastname: Pegoraro
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D010865:Pilot Projects; D012141:Respiratory Tract Infections / Q000209:etiology / Q000628:therapy; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: acute respiratory failure; amyotrophic lateral sclerosis; hospital at home; neuromuscular disorder; noninvasive ventilation; respiratory-tract infection