Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients

C. Hernandez, A. Casas, J. Escarrabill, J. Alonso, J. Puig-Junoy, E. Farrero, G. Vilagut, B. Collvinent, R. Rodriguez-Roisin, J. Roca*, A. Alonso, J. A. Montero, J. Pastor, B. Sifre, F. del Pozo, P. de Toledo, S. Jiménez, F. Ortiz, L. Mena, M. GodoyJ. Luís Sirera, J. Aguiló, L. Sánchez, A. Guimerà, A. Falco, D. Balconi, B. Andrés, J. J. Moratillas, A. Mattiussi, A. Antonini, C. Castiglioni, E. Battaglia, F. Moggio, M. Mercinelli, F. Van de Werf, P. Sylvester, N. Pougetoux, M. A. García Matatoros, A. Marcus, R. Farré, C. Céinos

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

177 Citations (Scopus)

Abstract

It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation. To this end, 222 COPD patients (3.2% female; 71±10 yrs (mean±SD)) were randomly assigned to HH (n=121) or conventional care (n=101). During HH, integrated care was delivered by a specialised nurse with the patient's free-phone access to the nurse ensured for an 8-week follow-up period. Mortality (HH: 4.1%; controls: 6.90%) and hospital readmissions (HH: 0.24±0.57; controls: 0.38±0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13±0.43 versus 0.31±0.62); and 2) a noticeable improvement of quality of life (Δ St George's Respiratory Questionnaire (SGRQ), -6.9 versus -2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient's satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7±2.3 versus 4.2±4.1 days). A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.

Original languageEnglish
Pages (from-to)58-67
Number of pages10
JournalEuropean Respiratory Journal
Volume21
Issue number1
DOIs
Publication statusPublished - 1 Jan 2003

Keywords

  • Chronic obstructive pulmonary disease
  • Healthcare costs
  • Healthcare services
  • Home care
  • Hospitalisation

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