Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? : A Randomized Trial.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
pubmed:
20
4
2021
medline:
9
9
2021
entrez:
19
4
2021
Statut:
ppublish
Résumé
Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain. To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons. Multisite randomized trial. (ISRCTN registry number: ISRCTN60477865). 9 hospital and community sites in the United Kingdom. 1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission. Admission avoidance HAH with CGA versus hospital admission with CGA when available using 2:1 randomization. The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction. Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15]; The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected. Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons. The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66).
Sections du résumé
BACKGROUND
Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain.
OBJECTIVE
To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons.
DESIGN
Multisite randomized trial. (ISRCTN registry number: ISRCTN60477865).
SETTING
9 hospital and community sites in the United Kingdom.
PATIENTS
1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission.
INTERVENTION
Admission avoidance HAH with CGA versus hospital admission with CGA when available using 2:1 randomization.
MEASUREMENTS
The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction.
RESULTS
Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15];
LIMITATION
The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected.
CONCLUSION
Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons.
PRIMARY FUNDING SOURCE
The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66).
Identifiants
pubmed: 33872045
doi: 10.7326/M20-5688
pmc: PMC7612132
mid: EMS138144
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
889-898Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
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