Hospital in the home: a randomised controlled trial

Objectives: To compare treatment of acute illness at home and in hospital, assessing safety, effect on geriatric complications, and patient/carer sati sfaction. Design: Randomised controlled trial. Setting: A tertiary referral hospital affiliated with the University of New South Wales. Participants: 100 patients (69% older than 65 years) with a variety of acut e conditions, who were assessed in the emergency department as requiring ad mission to hospital. Interventions: Patients were allocated at random to be treated by a hospita l-in-the-home (HIH) service in their usual residence or to be admitted to h ospital. Main outcome measures: Geriatric complications (confusion, falls, urinary i ncontinence or retention, faecal incontinence or constipation, phlebitis an d pressure areas), patient/carer satisfaction, adverse events, and death. Results: There was a lower incidence of confusion (0 v. 20.4% [95% CI, 9.1% -31.7%]; P = 0.0005), urinary complications (incontinence or retention) (2. 0% [95% CI, -1.8%, 5.8%] v. 16.3% [95% CI, 6.0%, 26.6%]; P = 0.01), and bow er complications (incontinence or constipation) (0 v. 22.5% [95% CI, 10.7%, 34.1%]; P = 0.0003) among HIH-treated patients. No significant difference in number of adverse events and deaths (to 28 days after discharge) in the two groups was found (although numbers were small). Patient and carer satis faction was significantly higher in the HIH group. Conclusions: Home treatment appears to provide a safe alternative to hospit alisation for selected patients, and may be preferable for some older patie nts. We found high levels of both patient and carer satisfaction with home treatment.