PROSPECTIVE EVALUATION OF CLINICAL-CRITERIA TO SELECT OLDER PERSONS WITH ACUTE MEDICAL ILLNESS FOR CARE IN A HYPOTHETICAL HOME HOSPITAL

OBJECTIVE: To evaluate criteria to select older persons who need hospi talization for common acute medical illnesses for care in a hypothetic al home hospital. DESIGN: Prospective record review. SETTING AND PARTI CIPANTS: Patients aged 65 and older admitted to the general medical se rvice of a community-based university hospital. MEASUREMENTS: We devel oped illness-specific selection criteria to identify older persons wit h certain acute medical conditions for treatment in a hypothetical hom e hospital. The selection criteria were reviewed prospectively against all community-dwelling older patients admitted to the general medical service of a community-based university hospital over a 4-month perio d. We determined eligibility for home hospital admission based on info rmation available at the time of admission and then tracked the patien t's hospital course. RESULTS: One hundred fifty-seven admissions of 14 3 patients were reviewed. The selection criteria identified 33% of pat ients admitted to the acute hospital with one of the three target diag noses as eligible for a home hospital model of care had it been availa ble. Eligible patients experienced shorter lengths of stay (3.7 vs 5.4 days, P =.012), fewer mean number of procedures performed (0.98 vs 1. 70, P =.001), fewer mean number of complications (0.17 vs 0.56, P = .0 10), and fewer events that could be handled only in the acute hospital setting (P =.036). In addition, in logistic regression analysis, thre e criteria for home hospital ineligibility, pulmonary congestion assoc iated with ischemic chest pain (odds ratio 6.85, 95% CI 2.64, 17.81), the presence of an acute coexisting illness requiring hospitalization independent of the target conditions (odds ratio 2.66, 95% CI 1.11, 6. 41), and significant pulmonary congestion after initial treatment (odd s ratio 14.4, 95% CI 1.77, 117.41) were significantly associated with items difficult to accomplish at home. CONCLUSIONS: Criteria can be de lineated that identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital.