BMJ 1998;316:1786-1791 ( 13 June )

General Practice

Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes

Editorial by IliffeGeneral practice pp 1791, 1796, 1802

Sasha Shepperd, research officer, a Diana Harwood, research assistant, b Crispin Jenkinson, deputy director, b Alastair Gray, director, c Martin Vessey, professor of public health and head of department, a Patrick Morgan, consultant in public health medicine. d

a Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF , b Health Services Research Unit, Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, c Health Economics Research Centre, Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, d Northamptonshire Health Authority, Northampton NN1 5DN

Correspondence to: Sasha Shepperd Sasha.Shepperd{at}dphpc.ox.ac.uk

Objectives: To compare hospital at home care with inpatient hospital care in terms of patient outcomes.
Design: Randomised controlled trial with three month follow up.
Setting: District general hospital and catchment area of neighbouring community trust.
Subjects: Patients recovering from hip replacement (n=86), knee replacement (n=86), and hysterectomy (n=238); elderly medical patients (n=96); and patients with chronic obstructive airways disease (n=32).
Interventions: Hospital at home care or inpatient hospital care.
Main outcome measures: Dartmouth COOP chart to measure patients' general health status; SF-36 to measure possible limitations in physical functioning of patients with hysterectomy; disease specific measures---chronic respiratory disease questionnaire, Barthel index for elderly medical patients, Oxford hip score, and Bristol knee score; hospital readmission and mortality data; carer strain index to measure burden on carers; patients' and carers' preferred form of care.
Results: At follow up, there were no major differences in outcome between hospital at home care and hospital care for any of the patient groups except that those recovering from hip replacement reported a significantly greater improvement in quality of life with hospital at home care (difference in change from baseline value 0.50, 95% confidence interval 0.13 to 0.88). Hospital at home did not seem suitable for patients recovering from a knee replacement, as 14 (30%) of patients allocated to hospital at home remained in hospital. Patients in all groups preferred hospital at home care except those with chronic obstructive airways disease. No differences were detected for carer burden. Carers of patients recovering from knee replacement preferred hospital at home care, while carers of patients recovering from a hysterectomy preferred hospital care.
Conclusions: Few differences in outcome were detected. Thus, the cost of hospital at home compared with hospital care becomes a primary concern.

Key messages

  • Hospital at home schemes are a popular alternative to standard hospital care, but there is uncertainty about their cost effectiveness

  • In our randomised controlled trial we compared hospital at home care with inpatient hospital care for patients recovering from hip replacement, knee replacement, and hysterectomy; elderly medical patients; and those with chronic obstructive airways disease

  • There were no major differences in patients' reported health outcomes between the two treatments, but, because of complications commonly needing hospitalisation, patients recovering from knee replacement did not seem suitable for hospital at home care

  • All patient groups except those with chronic obstructive airways disease preferred hospital at home care

  • Carers of patients recovering from a hysterectomy preferred hospital care, while those of patients recovering from a knee replacement preferred hospital at home care



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Rapid Responses:

Read all Rapid Responses

Hospital at home:not the only alternative to district general hospital care
David A Seamark
bmj.com, 11 Aug 1998 [Full text]
Patients need choices
Ed Peile, et al.
bmj.com, 28 Aug 1998 [Full text]
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