RANDOMIZED CONTROLLED TRIAL COMPARING HOSPITAL AT HOME CARE WITH INPATIENT HOSPITAL-CARE - I - 3 MONTH FOLLOW-UP OF HEALTH OUTCOMES

Objectives: To compare hospital at home care with inpatient hospital c are in terms of patient outcomes. Design: Randomised controlled trial with three month follow up. Setting: District general hospital and cat chment area of neighbouring community trust. Subjects: Patients recove ring from hip replacement (n = 86), knee replacement (n = 86), and hys terectomy (n = 238); elderly medical patients (n = 96); and patients w ith chronic obstructive airways disease (n = 32). Interventions: Hospi tal at home care or inpatient hospital care. Main outcome measures: Da rtmouth COOP chart to measure patients' general health status; SF-36 t o measure possible limitations in physical functioning of patients wit h 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 d ifferences in outcome between hospital at home care and hospital care for any of the patient groups except that those recovering from hip re placement reported a significantly greater improvement in quality of l ife with hospital at home care (difference in change from baseline val ue 0.50, 95% confidence interval 0.13 to 0.88). Hospital at home did n ot seem suitable for patients recovering from a knee replacement, as 1 4 (30%) of patients allocated to hospital at home remained in hospital . Patients in all groups preferred hospital at home care except chose 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 differenc es in outcome were detected. Thus, the cost of hospital at home compar ed with hospital care becomes a primary concern.