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Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.


ABSTRACT: BACKGROUND:Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. OBJECTIVE:Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. DESIGN:Randomized controlled trial. PARTICIPANTS:Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. INTERVENTION:Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. MAIN MEASURES:Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. KEY RESULTS:Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p?=?0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p?

SUBMITTER: Levine DM 

PROVIDER: S-EPMC5910347 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

Levine David M DM   Ouchi Kei K   Blanchfield Bonnie B   Diamond Keren K   Licurse Adam A   Pu Charles T CT   Schnipper Jeffrey L JL  

Journal of general internal medicine 20180206 5


<h4>Background</h4>Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.<h4>Objective</h4>Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience.<h4>Design</h4>Ran  ...[more]

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