Randomised controlled trial of effectiveness of Leicester hospital at home scheme compared with hospital care

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Abstract
Objective: To compare effectiveness of patient care in hospital at home scheme with hospital care. Design: Pragmatic randomised controlled trial. Setting: Leicester hospital at home scheme and the city's three acute hospitals. Participants: 199 consecutive patients referred to hospital at home by their general practitioner and assessed as being suitable for admission. Six of 102 patients randomised to hospital at home refused admission, as did 23 of 97 allocated to hospital. Intervention: Hospital at home or hospital inpatient care. Main outcome measures: Mortality and change in health status (Barthel index, sickness impact profile 68, EuroQol, Philadelphia geriatric morale scale) assessed at 2 weeks and 3 months after randomisation. The main process measures were service inputs, discharge destination, readmission rates, length of initial stay, and total days of care. Results: Hospital at home group and hospital group showed no significant differences in health status (median scores on sickness impact profile 68 were 29 and 30 respectively at 2 weeks, and 24 and 26 at 3 months) or in dependency (Barthel scores 15 and 14 at 2 weeks and 16 for both groups at 3 months). At 3 months' follow up, 26 (25%) of hospital at home group had died compared with 30 (31%) of hospital group (relative risk 0.82 (95% confidence interval 0.52 to 1.28)). Hospital at home group required fewer days of treatment than hospital group, both in terms of initial stay (median 8 days v 14.5 days, P=0.026) and total days of care at 3 months (median 9 days v 16 days, P=0.031). Conclusions: Hospital at home scheme delivered care as effectively as hospital, with no clinically important differences in health status. Hospital at home resulted in significantly shorter lengths of stay, which did not lead to a higher rate of subsequent admission. The effectiveness of hospital at home schemes for avoiding hospital admission has not been tested in a trial In this study patients suitable for hospital at home care were randomised to hospital at home or hospital care and followed up for three months There were no clinically or statistically significant differences in outcome as measured by the sickness impact profile 68, Barthel index, Philadelphia geriatric morale scale, and EuroQol Length of stay in care and total days of care were about 45% less for patients randomised to hospital at home For patients who meet the admission criteria, hospital at home schemes can provide an effective and acceptable alternative to hospital admission