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Patients Prefer Home vs. Hospital Care for Acute Illness



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Am Fam Physician. 2006 Dec 15;74(12):2109-2110.

Hospital at Home is a new model of care that provides an alternative to hospitalization. Leff and colleagues conducted a study evaluating patient and family satisfaction to determine the effectiveness of the physician-led Hospital at Home program.

This prospective, nonrandomized trial was conducted in three Medicare managed care plans and a veterans medical center. An 11-month intervention phase identified patients who required admission for community-acquired pneumonia, exacerbation of chronic heart failure or chronic obstructive pulmonary disease, or cellulitis. Patients who were eligible for the study were given the option of receiving their care at home through the Hospital at Home program or in a hospital setting.

The study evaluated responses to questions about patient satisfaction in several domains of patient care, such as relationships with the physicians and nurses and the admission and discharge process. A questionnaire was administered by telephone two weeks after admission. Sociodemographic information, diagnoses, physical and cognitive status, and other health data not obtained from the patient’s chart were abstracted from the medical records.

Of the 84 patients who received Hospital at Home care, 63 (75 percent) completed the telephone survey. Of the 130 patients treated in the hospital setting, 57 refused home care and 73 patients could not be considered for home care because they were admitted during hours when no one was servicing the Hospital at Home admissions process. These hospital patients were pooled and 46 completed the interview at two weeks. The families of 64 home care patients (76 percent) and 39 hospital patients (30 percent) completed satisfaction surveys. There were no significant sociodemographic differences between groups, although the Hospital at Home patients had more functional impairment. A greater percentage of Hospital at Home patients and their families were satisfied with their care, with statistically significant differences in five and six of the eight domains assessed, respectively (see accompanying table). Odds ratios adjusted for health status and other variables showed that patients and families who chose home care were more likely to be satisfied with their relationship with physicians, with the comfort and convenience of care, and with the overall care compared with patients who were given care in a hospital setting.

Preference of Patients and Families for Hospital at Home vs. Traditional Hospital Care by Domain

Domain Patients Families

Admission

Yes

No

Discharge

No

Yes

Comfort and convenience

Yes

Yes

Nurse relationship

No

Yes

Other staff

Yes

Yes

Pain control

No

Not measured

Physician relationship

Yes

Yes

Safety

No

No

Overall satisfaction

Yes

Yes


Yes = significantly greater proportion satisfied with Hospital at Home; No = no significant difference.

Preference of Patients and Families for Hospital at Home vs. Traditional Hospital Care by Domain

View Table

Preference of Patients and Families for Hospital at Home vs. Traditional Hospital Care by Domain

Domain Patients Families

Admission

Yes

No

Discharge

No

Yes

Comfort and convenience

Yes

Yes

Nurse relationship

No

Yes

Other staff

Yes

Yes

Pain control

No

Not measured

Physician relationship

Yes

Yes

Safety

No

No

Overall satisfaction

Yes

Yes


Yes = significantly greater proportion satisfied with Hospital at Home; No = no significant difference.

Overall, patients and families were more satisfied when they received substitutive hospital care at home than in the hospital setting. They especially preferred the admissions process and the comfort and convenience of home care. Irrespective of the setting, however, all patients felt safe with the care they received.

Leff B, et al. Satisfaction with Hospital at Home care. J Am Geriatr Soc. September 2006;54:1355–63.


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