HOSPITAL-AT-HOME FOR ADVANCED CANCER-PATIENTS WITHIN THE FRAMEWORK OFTHE BOLOGNA EUBIOSIA PROJECT - AN EVALUATION

Aims and background: An evaluation of the Bologna Hospital-at-Home (BH H) was undertaken to examine the following aspects: 1) median daily co sts of the BHH; 2) delivery of medical services; 3) patient satisfacti on with the care received and frequency of requests for transfer to th e alternative setting. Delivery of services and patient's satisfaction in the BHH were compared with data collected for a traditional hospit al (Ospedale Sant'Orsola Malpighi, Bologna - OSM). Methods: Our analys is was performed as a cost analysis considering two periods of time in 1992 and 1993/94. included were direct and indirect costs; no intangi ble costs were found. The patient's perspective was selected for the a nalysis. The observational study examining delivery of service and qua lity of life of patients admitted to the two care settings, BHH and OS M, considered patient's clinical history and an Interview conducted by the evaluation team 6 weeks after admission to either facility. Data included patient's characteristics, quantity of diagnostic and therape utic measures, circumstances of life, satisfaction with the care recei ved, and intention for transfer to the alternative setting of nursing. The statistical significance of our assumption of comparable care int ensity and better patient quality of life in the BHH was tested by the Pearson Chi-square test. Results: A survey was carried out of 236 pat ients treated in the or the OSM, The setting of assistance did not inf luence the provision of services. The time of ''talking to the doctor' ' was notably higher for BHH than for OSM patients. The analysis of sa tisfaction showed that 98% of the surveyed BHH patients believed it ma tched the actual needs. The quality of life was considered to be reduc ed/bad in 67% of the OSM patients but in only 51% of BHH patients. An opinion was also requested with regard to transfer to the alternative setting of nursing: 47% of OSM patients judged BHH care would be bette r than traditional hospital. The median daily costs in BHH reached 118 ,789 Lire (range, 108,569-129,027 Lire, depending on performance statu s). Conclusions: Although the economic advantage of hospital-at-home c are certainly is important, we would like to stress that better qualit y and dignity of life should be the main point supporting the idea of hospital-at-home care.