Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur

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Abstract
The community health services in Southern Derbyshire, in conjunction with an acute hospital, established a pilot scheme for the early discharge of fractured neck of femur patients from hospital to their own homes. The scheme was evaluated by prospectively comparing a group of patients using Hospital at Home (HAH) and a group receiving hospital care only. The main outcomes measured were the proportion of hospital admissions for fractured neck of femur using HAH, length of stay, patient satisfaction, general health status at discharge as measured by the Nottingham Health Profile, and three-month mortality and readmission rates. Costs were calculated based on prices charged by providers of the services. In the first year of the scheme, 76 (18 per cent) of the 432 hospital admissions for fractured neck of femur fitted the selection criteria and agreed to admission to HAH. Thirty-four patients were identified who were suitable for HAH but not admitted to it. The comparison of the 76 HAH patients and 34 hospital patients revealed that HAH patients were discharged from hospital an average of 7 days earlier; patients in both groups were satisfied with the care they received; the general health status of the two groups at discharge was similar, with the exception that HAH patients had better emotional health on discharge from care; the three-month mortality rate was similar in both groups (5 per cent); the readmission rate for HAH patients appeared higher than for hospital patients but this difference was not statistically significant (15·8 per cent versus 8·8 per cent, Fisher's exact test, p = 0·187). The Community Health Services quoted a charge of £400–£450 per patient compared with acute hospital charges of £770 for seven days in a hospital orthopaedic bed; these costs are charges, not actual costs. HAH for the early discharge of fractured neck of femur patients is a feasible and acceptable form of care and method of releasing hospital beds. To determine the cost-effectiveness of HAH for this condition, a detailed costing exercise should be undertaken and the issue of readmission rates clarified.

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