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Clinical Trial
. 1998 Jun 13;316(7147):1796-801.
doi: 10.1136/bmj.316.7147.1796.

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care

S H Richards  1 , J Coast, D J Gunnell, T J Peters, J Pounsford, M A Darlow
Affiliations
Clinical Trial

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care

S H Richards et al. BMJ. .

Erratum in

  • BMJ 1998 Sep;317(7161):786

Abstract

Objective: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital.

Design: Pragmatic randomised controlled trial.

Setting: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people.

Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate.

Interventions: Patients' received hospital at home care or routine hospital care.

Main outcome measures: Patients' quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months.

Results: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme.

Conclusions: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.

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Figures

Figure
Figure
Passage of patients through trial of hospital at home scheme
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Comment in

References

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    1. Council on Scientific Affairs. Home care in the 1990s. JAMA. 1990;263:1241–1244. - PubMed
    1. Costain D, Warner M, eds. From hospital to home care. London: King’s Fund, 1992.
    1. Pryor GA, Williams DRR. Rehabilitation after hip fractures. Home and hospital management compared. J Bone Joint Surg Br. 1989;71:471–473. - PubMed

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