title: The treatment of nursing home-acquired pneumonia using a medically intensive Hospital in the Home service.
abstract: OBJECTIVE
  To compare the outcomes for patients with nursing home-acquired pneumonia (NHAP) treated completely in a Hospital in the Home (HITH) setting with those of patients treated in a traditional hospital ward.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  All patients admitted by the Royal Melbourne Hospital for treatment of NHAP from 1 July 2013 to 31 January 2014.
  
  
  METHODS
  Admission to the Royal Melbourne Hospital HITH Unit within 48 hours of presentation.
  
  
  METHODS
  Length of stay, in-hospital and 30-day mortality, hospital readmissions (30-day), complications and unplanned returns to hospital.
  
  
  RESULTS
  Sixty HITH patients and 54 hospital (control) patients were identified. Thirty-two patients (53%) were admitted directly to HITH without any hospital or emergency stay, 25 (42%) were referred directly from the emergency department. HITH patients were more likely to be male, older and dehydrated, and less likely to have an advanced care directive or to have had non-invasive ventilation. There were no significant differences in CURB-65 or CORB scores between the two patient groups; similar proportions were given intravenous fluids or supplemental oxygen. There were no adjusted differences in median length of stay between HITH and control patients (-1.00 days; 95% CI, -2.72 to 0.72; P = 0.252) or in overall mortality at 30 days (HITH v control patients: adjusted odds ratio [aOR], 1.97; 95% CI, 0.67-5.73). Inpatient mortality was lower for HITH patients (aOR, 0.19; 95% CI, 0.05-0.75) but unadjusted postdischarge 30-day mortality was higher (OR, 13.25; 95% CI 1.67-105.75). There were no differences between the two groups with regard to complications (falls and pressure wounds) and 30-day readmission rates (aOR, 1.59; 95% CI, 0.30-8.53).
  
  
  CONCLUSIONS
  This study suggests that HITH may be an effective and safe alternative to hospital treatment for residents of aged care facilities presenting with NHAP.
authors.affiliation: Hospital in the Home, Royal Melbourne Hospital, Melbourne, VIC michael.montalto@mh.org.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Montalto
authors.affiliation: Queen Elizabeth Hospital, Hong Kong, China.
authors.forename: Man Yee
authors.initials: MY
authors.lastname: Chu
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, VIC.
authors.forename: Irani
authors.initials: I
authors.lastname: Ratnam
authors.affiliation: Victorian Infectious Diseases Service, Melbourne, VIC.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: NHMRC National Centre for Antimicrobial Stewardship and Guidance, Doherty Institute for Infection and Immunity, Melbourne, VIC.
authors.forename: Karin
authors.initials: K
authors.lastname: Thursky
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006699:Home Care Services; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D009735:Nursing Homes; D016017:Odds Ratio; D010359:Patient Readmission / Q000639:trends; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology