Skwarska E, Cohen G, Skwarski K M, Lamb C, Bushell D, Parker S, MacNee W
Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Thorax. 2000 Nov;55(11):907-12. doi: 10.1136/thorax.55.11.907.
A randomised trial was performed on patients presenting to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) to compare outcomes in those managed at home with support with those admitted to hospital in the standard manner.
Over an 18 month period all patients presenting to the Royal Infirmary of Edinburgh on weekdays (n=718) with a diagnosis of an exacerbation of COPD were assessed for inclusion in the trial. Patients with impaired level of consciousness, acute confusion, acute changes on radiography, or an arterial pH of <7.35 or with other serious medical or social reasons for admission were excluded. Patients randomised to home support were discharged with an appropriate treatment package (antibiotics, corticosteroids, nebulised bronchodilators and, if necessary, home oxygen). They were visited by a nurse the following day and thereafter at intervals of 2-3 days until recovery when they were discharged from follow up. Parallel observations were made on patients allocated to normal hospital admission up to the point of discharge. Patients in both groups were assessed at home eight weeks after the initial assessment.
Among weekday patients 353 (50%) were considered obligatory admissions, 140 (19%) were admitted because of co-morbidity, 17 (2%) because of poor social circumstances, and 24 (3%) did not consent to the trial. The remaining 184 (26%) were randomised (2:1) either to home support or to a standard hospital admission. The median time to discharge was 7 days for the home support group and 5 days for the admitted group (p<0.01); 25% of the home support group and 34% of the admitted group were readmitted before the final assessment at eight weeks (p>0.05). There were no significant differences between the groups in attendances by GPs and carers or in health status measured eight weeks after the initial assessment. Satisfaction with the service was good. The mean total health service cost per patient was estimated as 877 pounds sterling for the home support group and 1753 pounds sterling for the admitted group.
This study shows that home supported discharge is a well tolerated, safe, and economic alternative to hospital admission for a proportion of patients referred to hospital for admission for an exacerbation of COPD.
对因慢性阻塞性肺疾病（COPD）急性加重而住院的患者进行了一项随机试验，以比较在家中接受支持治疗的患者与以标准方式住院治疗的患者的结局。
在18个月期间，对平日到爱丁堡皇家医院就诊（n = 718）且诊断为COPD急性加重的所有患者进行评估，以确定是否纳入试验。排除意识水平受损、急性意识模糊、影像学有急性变化、动脉血pH值<7.35或因其他严重医疗或社会原因需要住院的患者。随机分配到家庭支持组的患者出院时接受适当的治疗方案（抗生素、皮质类固醇、雾化支气管扩张剂，必要时提供家庭氧气）。次日由护士进行家访，此后每隔2 - 3天家访一次，直至康复后停止随访。对分配到常规住院治疗的患者进行平行观察直至出院。两组患者在初始评估八周后在家中进行评估。
在平日就诊的患者中，353例（50%）被认为必须住院，140例（19%）因合并症住院，17例（2%）因社会情况不佳住院，24例（3%）不同意参加试验。其余184例（26%）被随机（2:1）分配到家庭支持组或标准住院组。家庭支持组的中位出院时间为7天，住院组为5天（p<0.01）；家庭支持组的25%和住院组的34%在八周的最终评估前再次入院（p>0.05）。两组在全科医生和护理人员的出诊次数或初始评估八周后测量的健康状况方面没有显著差异。对服务的满意度良好。家庭支持组每位患者的平均总医疗服务成本估计为877英镑，住院组为1753英镑。
本研究表明，对于一部分因COPD急性加重而转诊住院的患者，家庭支持出院是一种耐受性良好、安全且经济的替代住院治疗的方式。
