Older persons' preferences for home vs hospital care in the treatment of acute illness

Background; Although the home is expanding as a potential site for acute il lness treatment, little is known about patients' preferences for home vs th e hospital. Objective: To determine older persons' preferences for home or hospital as a treatment site for acute illness and factors associated with preference. Methods: Two hundred forty-six community-dwelling persons aged 65 years or older hospitalized with congestive heart failure, chronic obstructive pulmo nary disease, or pneumonia were identified in 2 urban teaching hospitals an d received telephone interviews 2 months after hospitalization. They were a sked their preference for home or hospital treatment, given the availabilit y of equivalent therapies and outcomes at the 2 sites and a nursing visit a nd several hours of home health aide assistance daily in the home. They wer e also asked about changes in preference with changes in the description of the outcome or the availability of services. Results: If home and hospital offered equivalent outcomes, 46% of the sampl e preferred treatment at home. Preferences were heavily dependent on the ou tcome of the illness, physician opinion about the best site of care, and th e provision of house calls. Higher education, white race, living with a spo use, being deeply religious, and having 2 or more dependencies in activitie s of daily living were associated with a preference for home treatment. Conclusions: Under conditions of equivalent outcome, preferences for treatm ent site are almost equally divided between home and hospital. Explicit elu cidation of preferences is necessary if patients' preferences are to play a meaningful role in decision making about site of care.