Abstract
Background: The “Hospital at home” (HH) model may provide adequate care without an adverse effect on clinical outcome and is generally well-received by users. Our objective was to compare HH and inpatient hospital care for Neuro-Muscular Disease (NMD) patients with Respiratory Tract Infection (RTI).
Methods: Design: Prospective randomised controlled trial. Setting: University teaching hospital offering secondary care service to 500,000 patients. Patients: Selected NMD patients with RTI where hospital admission had been recommended after medical assessment. Interventions: HH was provided as an alternative to inpatient admission. Main outcome measures: need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, cost of patient care.
Results: Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for HH. Twenty-six patients were randomised to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, p=0.19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 days p=0.21) or mortality at three months (3/26 vs 4/27 deaths; p=0.42) between the groups. HH failure was independently correlated with type of NMD (p=0.0037) with an OR of failure of 17.3 (95% CI, 2.1 to infinity) for patients with Amyotrophic Lateral Sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the patients who were successfully treated at home compared to hospitalised individuals.
Conclusions: HH is an effective alternative to hospital admission for selected MND patients with RTI.
- Neuromuscular Disorder
- Acute Respiratory Failure
- Non-Invasive Ventilation
- Hospital at Home
- Amyotrophic Lateral Sclerosis
- Respiratory Tract Infection
Footnotes
- Correspondence: Andrea Vianello, MD; U.O. Fisiopatologia Respiratoria Azienda Ospedaliera di Padova Via Giustiniani, 2 35128 PADOVA — Italy, Phone: 0039-049-8218587, Fax: 0039-049-8218590, avianello{at}qubisoft.it
STATEMENT OF INTERESTS We all Authors declare that we have no financial and personal relationships with people or organizations that could have inappropriately influenced (bias) our work. No study sponsor has been involved in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. We have no conflicts of interest to declare.
SOURCES OF FINANCIAL SUPPORT This study was supported, in part, by grants from the “Associazione Distrofia Muscolare”, the “Associazione Sclerosi Laterale Amiotrofica” and the “Unione Italiana Lotta Distrofia Muscolare”.
- Copyright © 2013 by Daedalus Enterprises Inc.