Substitutive “Hospital at Home” Versus Inpatient Care for Elderly Patients with Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Randomized, Controlled Trial

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Abstract
OBJECTIVES: To evaluate hospital readmission rates and mortality at 6‐month follow‐up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).DESIGN: Prospective randomized, controlled, single‐blind trial with 6‐month follow‐up.SETTING: San Giovanni Battista Hospital of Torino.PARTICIPANTS: One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were randomly assigned to a general medical ward (GMW, n=52) or to a geriatric home hospitalization service (GHHS, n=52).MEASUREMENTS: Measurements of baseline sociodemographic information; clinical data; functional, cognitive, and nutritional status; depression; and quality of life were obtained.RESULTS: There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6‐month follow‐up (42% vs 87%, P<.001). Cumulative mortality at 6 months was 20.2% in the total sample, without significant differences between the two study groups. Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW (15.5±9.5 vs 11.0±7.9 days, P=.010). Only GHHS patients experienced improvements in depression and quality‐of‐life scores. On a cost per patient per day basis, GHHS costs were lower than costs in GMW ($101.4±61.3 vs $151.7±96.4, P=.002).CONCLUSION: Physician‐led substitutive hospital‐at‐home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months, lower healthcare costs, and better quality of life.