RANDOMIZED CONTROLLED TRIAL COMPARING EFFECTIVENESS AND ACCEPTABILITYOF AN EARLY DISCHARGE, HOSPITAL AT HOME SCHEME WITH ACUTE HOSPITAL-CARE

Objective: to compare effectiveness and acceptability of early dischar ge to a hospital at home scheme with that of routine discharge from ac ute hospital. Design: Pragmatic randomised controlled trial. Setting: Acute hospital wards and community in north of Bristol, with a catchme nt population of about 224 000 people. Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early dis charge to hospital at home scheme and who consented to participate. In terventions: Patients' received hospital at home care or routine hospi tal care. Main outcome measures: Patients' quality of life, satisfacti on, and physical functioning assessed at 4 weeks and 3 months after ra ndomisation to treatment; length of stay in hospital and in hospital a t home scheme after randomisation; mortality at 3 months. Results: The re were no significant differences in patient mortality, quality of li fe, and physical functioning between the two arms of the trial at 4 we eks or 3 months. Only one of 11 measures of patient satisfaction was s ignificantly different: hospital at home patients perceived higher lev els of involvement in decisions. Length of stay for those receiving ro utine hospital care was 62% (95% confidence interval 51% to 75%) of le ngth of stay in hospital at home scheme. Conclusions: The early discha rge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.