Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients

Abstract

It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation.To this end, 222 COPD patients (3.2% female; 71¡10 yrs (mean¡SD)) were randomly assigned to HH (n=121) or conventional care (n=101). During HH, integrated care was delivered by a specialised nurse with the patient9s free-phone access to the nurse ensured for an 8-week follow-up period.Mortality (HH: 4.1%; controls: 6.9%) and hospital readmissions (HH: 0.24¡0.57; controls: 0.38¡0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13¡0.43 versus 0.31¡0.62); and 2) a noticeable improvement of quality of life (D St George9s Respiratory Questionnaire (SGRQ), -6.9 versus -2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient9s satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7 ¡ 2.3 versus 4.2 ¡ 4.1 days).A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.

Technology and its role in respiratory care

“…These technologies can take any number of forms such as web-based applications, 3 mobile phone and alert systems, 4,5 telephone and video conferencing with patients, 6,7 as well as any combination of these applications. In the last five years there has been a rapid increase in the use of monitoring technology as a management tool for long-term conditions despite a lack of robust evidence of clinical benefit to patients.…”

Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio en España

“…En los últimos años se han sucedido las publicaciones de costes en HAD y en la actualidad disponemos de un cuerpo de evidencia suficiente para poder afirmar que se trata de un modelo asistencial coste-efectivo, aunque no todos los estudios han resultado concluyentes en este sentido (16,(23)(24)(25)(26)(27).…”

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

“…En este apartado se incluyeron cuatro artículos con 455 pacientes [29][30][31][32] . En pacientes con EPOC con agudización que acudían a urgencias o eran ingresados, distintas intervenciones a domicilio han conseguido reducir los días de estancia 29,30,32 , las nuevas consultas a urgencias 30,32 , o el número de ingresos 29,30 .…”

“…En pacientes con EPOC con agudización que acudían a urgencias o eran ingresados, distintas intervenciones a domicilio han conseguido reducir los días de estancia 29,30,32 , las nuevas consultas a urgencias 30,32 , o el número de ingresos 29,30 . La hospitalización en el domicilio de los pacientes con IC consiguió los mismos resultados en términos de mortalidad o reingreso que la hospitalización convencional 31 .…”