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Copyright ©ERS Journals Ltd 2003
Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients
1 Servei de Pneumologia (ICPCT) and 5 Servei d'Urgències, Hospital Clínic, IDIBAPS, 2 UFISS-Respiratòria (Servei de Pneumologia), Hospital Universitari de Bellvitge Universitat de Barcelona, 3 Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS) and 4 Research Center for Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
CORRESPONDENCE: J. Roca, Servei de Pneumologia, Hospital Clínic, Villarroel 170, Barcelona, 08036, Spain. Fax: 34 932275455. E-mail: jroca@clinic.ub.es
Keywords: chronic obstructive pulmonary diseasehealthcare costshealthcare serviceshome carehospitalisation
Received: February 21, 2002
Accepted July 26, 2002
Supported by Grants AATM 8/02/99 from the Agencia d'Avaluació de Tecnología Mèdica; FIS 98/0052-01 from the Fondo de Investigaciones Sanitarias; SEPAR 1998; CHRONIC project (IST-1999/12158) from the European Union (DG XIII); and, Comissionat per a Universitats i Recerca de la Generalitat de Catalunya (1999-SGR-00228). A. Casas was a predoctoral research fellow supported by CHRONIC and grant-in-aid by ESTEVE group.
It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation.
To this end, 222 COPD patients (3.2% female; 71±10 yrs (mean±sd)) were randomly assigned to HH (n=121) or conventional care (n=101). During HH, integrated care was delivered by a specialised nurse with the patient's free-phone access to the nurse ensured for an 8-week follow-up period.
Mortality (HH: 4.1%; controls: 6.9%) and hospital readmissions (HH: 0.24±0.57; controls: 0.38±0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13±0.43 versus 0.31±0.62); and 2) a noticeable improvement of quality of life (
A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.
St George's Respiratory Questionnaire (SGRQ), –6.9 versus –2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient's satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7±2.3 versus 4.2±4.1 days).
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