Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? A Randomized Trial

被引：1

作者：

Shepperd, Sasha ^{[1
]}

Butler, Chris ^{[2
]}

Cradduck-Bamford, Andrea ^{[1
]}

Ellis, Graham ^{[3
]}

Gray, Alastair ^{[4
]}

Hemsley, Anthony ^{[5
]}

Khanna, Pradeep ^{[6
]}

Langhorne, Peter ^{[7
]}

Mort, Sam ^{[2
]}

Ramsay, Scott ^{[8
]}

Schiff, Rebekah ^{[9
]}

Stott, David J. ^{[7
]}

Wilkinson, Angela ^{[10
]}

Yu, Ly-Mee ^{[2
]}

Young, John ^{[11
]}

机构：

[1] Univ Oxford, Nuffield Dept Populat Hlth Sci, Richard Doll Bldg,Old Rd Campus, Oxford OX3 7LF, England

[2] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Radcliffe Observ Quarter, Woodstock Rd, Oxford OX2 6GG, England

[3] NHS Lanarkshire, Univ Hosp Monklands, Monkscourt Ave, Airdrie ML6 0JS, Scotland

[4] Univ Oxford, Nuffield Dept Populat Hlth, Hlth Econ Res Ctr, Richard Doll Bldg, Oxford OX3 7LF, England

[5] Royal Devon & Exeter NHS Fdn Trust, Exeter EX2 5DW, Devon, England

[6] Aneurin Bevan Univ Hlth Board, Newport NP20 45Z, Gwent, Wales

[7] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow G12 8TA, Lanark, Scotland

[8] NHS Lothian, St Johns Hosp, Livingston EH54 6PP, Scotland

[9] Guys & St ThomasNHS Fdn Trust, Westminster Bridge Rd, London SE1 7EH, England

[10] NHS Fife, Victoria Hosp, Hayfield Rd, Kirkcaldy KY2 5AH, Scotland

[11] Univ Leeds, Leeds LS2 9JT, W Yorkshire, England

来源：

ANNALS OF INTERNAL MEDICINE | 2021年 / 174卷 / 07期

关键词：

CARE; PEOPLE;

D O I：

10.7326/M20-5688

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 2:1 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.

引用

页码：889 / +

页数：11

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