Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? : A Randomized Trial.
Ann Intern Med
; 174(7): 889-898, 2021 07.
Article
en En
| MEDLINE
| ID: mdl-33872045
ABSTRACT
BACKGROUND:
Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain.OBJECTIVE:
To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons.DESIGN:
Multisite randomized trial. (ISRCTN registry number ISRCTN60477865).SETTING:
9 hospital and community sites in the United Kingdom. PATIENTS 1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission. INTERVENTION Admission avoidance HAH with CGA versus hospital admission with CGA when available using 21 randomization. MEASUREMENTS The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction.RESULTS:
Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15]; P = 0.36); 114 of 673 (16.9%) versus 58 of 328 (17.7%) had died (RR, 0.98 [CI, 0.65 to 1.47]; P = 0.92); and 37 of 646 (5.7%) versus 27 of 311 (8.7%) were in long-term residential care (RR, 0.58 [CI, 0.45 to 0.76]; P < 0.001).LIMITATION:
The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected.CONCLUSION:
Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons. PRIMARY FUNDING SOURCE The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66).
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Evaluación Geriátrica
/
Servicios de Atención de Salud a Domicilio
Tipo de estudio:
Clinical_trials
/
Etiology_studies
Aspecto:
Patient_preference
Límite:
Aged
/
Aged80
/
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Ann Intern Med
Año:
2021
Tipo del documento:
Article