Article Text
PDF
Abstract
Background Previous models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.
Methods In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.
Results Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI −2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1–7), UC=5 (IQR 2–12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH being cost-effective was 90%. There was one death within 90 days in each arm, readmission rates were similar and 90% of patients preferred HAH for subsequent ECOPD.
Conclusion HAH selected by low-risk DECAF score was safe, clinically effective, cost-effective, and preferred by most patients. Compared with earlier models, selection is simpler and approximately twice as many patients are eligible. The introduction of DECAF was associated with a fall in UC length of stay without adverse outcome, supporting use of DECAF to direct early discharge.
Trial registration number Registered prospectively ISRCTN29082260.
- copd exacerbations
This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Statistics from Altmetric.com
Footnotes
Contributors SCB conceived the study and was chief investigator with overall responsibility for the management of the study. SCB, CE, JG and GJG were responsible for the study design, protocol and obtaining funding. AJS, JS and JM contributed to trial design. CE, SCB, and JG wrote the statistical analysis plan, with statistical input from Colin Muirhead. CE and TH recruited patients and collated data. CE and JG performed statistical analyses. CE drafted the original manuscript, and all authors helped write the final version.
Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0213-30105). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Funding was also provided by the Northumbria Healthcare NHS Foundation Trust Teaching and Research Fellowship Programme.
Competing interests SCB reports grants from NIHR: Research for Patient Benefit Programme, during the conduct of the study; HTA funding, grants from Philips Respironics and Pfizer Open Air, personal fees from Pfizer and AstraZeneca, outside the submitted work. JG reports grants from NIHR Research for Patient Benefit, during the conduct of the study. CE, GJG, TH, AJS and JS have no competing interests to declare.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the NRES Committee North East Sunderland (3/NE/0275). All participants gave informed consent before taking part in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement For any requests for data sharing, please contact the corresponding author.