Peterborough Hospital at Home: an evaluation

Abstract

An evaluation of the Peterborough Hospital at Home scheme was undertaken to examine the complementary roles of Hospital at Home, hospital ward and the District Nursing Service. The evaluation involved two surveys; the first was a retrospective study of records of patients admitted to one of the three care settings during 1983. The second survey was a prospective study of Hospital at Home patients in 1985 with the index diagnoses of malignant neoplasms, cerebrovascular accidents and post-operative patients discharged early from hospital. In 1985, 284 patients were admitted to Hospital at Home, and of these the largest group (73 patients) were terminally ill cancer patients. Hospital at Home provided care for more severely ill patients than those normally looked after by the District Nursing Service, and comparable in severity and outcome to those in hospital. There was an emphasis on terminal care by Hospital at Home which would make it appear to be an enhancement to the usual domiciliary nursing services available, as, for the majority of the cancer patients cared for by Hospital at Home, admission to hospital would probably not be sought.

Psychiatric disorder among children at time of entering local authority care: questionnaire study

“…One study found hospital at home more expensive per episode of care than standard hospital care. 19 Another found no difference in total healthcare costs between hospital at home and hospital care for patients with hip or knee replacements or general medical patients, but costs were higher in hospital at home for women who had had a hysterectomy and patients with chronic obstructive airways disease. 20 Two others found that the costs to the NHS of hospital at home were lower than those for standard hospital care patients.…”

“…17 Hospital at home schemes have enabled patients to be discharged early from hospital. 18 One study found total length of stay (both in hospital and then under hospital at home care) for hospital at home patients to be less than that for patients in hospital, 19 whereas others have found total length of stay for patients in hospital at home to be greater. 18 20 Evidence on costs of hospital at home compared with standard hospital care is also mixed.…”

Editorial. Caring for older hospital-at-home patients

“…Although the Peterborough scheme has been operational in the UK since 1978 [21], the only attempt at a randomized controlled study foundered because of the scheme's success: patients, their general practitioners and carers were reluctant to be randomized to treatment in hospital as they perceived that treatmentat-home was so successful [7]. In a prospective evaluation of the scheme, 16% of carers reported that involvement in caring had presented a problem and 31% that it had caused some burden [7].…”

“…In a prospective evaluation of the scheme, 16% of carers reported that involvement in caring had presented a problem and 31% that it had caused some burden [7]. Three groups of patients were studied: stroke, early post-operative discharge and those with malignant disease.…”

“…The study reported by Gunnell et al found hospital-at-home not to be associated with increased carer strain. However, the most established UK scheme found increased burden experienced by some hospital-at-home carers [7], and the statement that the ''implementation of hospital-at-home schemes should be influenced by considerations of their cost and effectiveness rather than their potential adverse effects on carers'' may be premature.…”