医学
恶化
呼吸衰竭
人口
随机对照试验
优势比
呼吸保健
呼吸道感染
不利影响
急诊医学
内科学
儿科
重症监护医学
呼吸系统
环境卫生
作者
Andrea Vianello,Francesca Savoia,Emanuela Pipitone,Beatrice Nordio,Giulia Gallina,Luciana Paladini,Alessandra Concas,Giovanna Arcaro,Federico Gallan,Elena Pegoraro
出处
期刊:Respiratory Care
[Daedalus Enterprises]
日期:2013-05-21
卷期号:58 (12): 2061-2068
被引量:36
标识
DOI:10.4187/respcare.02501
摘要
The "hospital-at-home" model may provide adequate care without an adverse effect on clinical outcome, and is generally well received by users. Our objective was to compare hospital-at-home and in-patient hospital care for neuromuscular disease (NMD) patients with respiratory tract infections.We conducted a prospective randomized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000. We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment. Hospital-at-home was provided as an alternative to in-patient admission. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, and cost of patient care.Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for hospital-at-home. Twenty-six subjects were randomized to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, P = .19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 d, P = .21), or mortality at 3 months (3/26 vs 4/27 deaths, P = .42) between the groups. Hospital-at-home failure was independently correlated with type of NMD (P = .004) with an odds ratio of failure of 17.3 (95% CI 2.1 to infinity) for subjects with amyotrophic lateral sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home, compared to the hospitalized individuals.Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections.
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