A randomized controlled trial of a high support hospital discharge team for elderly people

Abstract

The Home Treatment Team (HTT), a hospital discharge team for elderly patients, was created to provide practical help and promote independence of patients at home for up to 6 weeks after hospital discharge. Patients were those judged to be at particular risk of failing to resettle, and thus being readmitted to hospital or admitted to a residential or nursing home. An open randomized controlled trial compared patients receiving the HTT (n = 29) with controls (n = 25) receiving appropriate conventional community services. Fewer HTT patients were readmitted (four by 6 weeks and nine by 12 weeks) than controls (nine by 6 weeks and 14 by 12 weeks, p < 0.05) and more were at home at 6 weeks (24, 83% and 10, 40%, p < 0.05), 12 weeks (21, 72% and 11, 44%, p < 0.05) and 12 months (17, 58% and 10, 40%, p < 0.05). The HTT group spent fewer days in hospital than controls during 12 weeks (median difference 34 days, 95% confidence interval 0-75, p < 0.05) and more days at home during 12 months (90; 247-0, p = 0.02). Neither group showed any significant change in mental state or functional abilities over 12 weeks. Potentially confounding factors were considered insufficient explanation for the difference in outcome between the groups. It is concluded that the HTT was of benefit but the mechanism of its effect was not identified.