Davies L, Wilkinson M, Bonner S, Calverley P M, Angus R M
Department of Medicine, University Hospital Aintree, Liverpool L9 7AL, UK.
BMJ. 2000 Nov 18;321(7271):1265-8. doi: 10.1136/bmj.321.7271.1265.
To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease.
Prospective randomised controlled trial with three months' follow up.
University teaching hospital offering secondary care service to 350 000 patients.
Selected patients with an exacerbation of chronic obstructive pulmonary disease where hospital admission had been recommended after medical assessment.
Nurse administered home care was provided as an alternative to inpatient admission.
Readmission rates at two weeks and three months, changes in forced expiratory volume in one second (FEV(1)) from baseline at these times and mortality.
583 patients with chronic obstructive pulmonary disease referred for admission were assessed. 192 met the criteria for home care, and 42 refused to enter the trial. 100 were randomised to home care and 50 to hospital care. On admission, FEV(1) after use of a bronchodilator was 36.1% (95% confidence interval 2.4% to 69.8%) predicted in home care and 35.1% (6.3% to 63. 9%) predicted in hospital care. No significant difference was found in FEV(1 )after use of a bronchodilator at two weeks (42.6%, 3.4% to 81.8% versus 42.1%, 5.1% to 79.1%) or three months (41.5%, 8.2% to 74.8% versus 41.9%, 6.2% to 77.6%) between the groups. 37% of patients receiving home care and 34% receiving hospital care were readmitted at three months. No significant difference was found in mortality between the groups at three months (9% versus 8%).
Hospital at home care is a practical alternative to emergency admission in selected patients with exacerbations of chronic obstructive pulmonary disease.
比较“居家医院”模式与住院治疗对慢性阻塞性肺疾病急性加重期患者的效果。
前瞻性随机对照试验，随访3个月。
为35万患者提供二级护理服务的大学教学医院。
经医学评估后建议住院治疗的慢性阻塞性肺疾病急性加重期患者。
提供护士指导的居家护理作为住院治疗的替代方案。
两周和三个月时的再入院率、此时一秒用力呼气量（FEV₁）相对于基线的变化以及死亡率。
对583例被转诊住院的慢性阻塞性肺疾病患者进行了评估。192例符合居家护理标准，42例拒绝参加试验。100例被随机分配至居家护理组，50例被分配至住院治疗组。入院时，居家护理组使用支气管扩张剂后的FEV₁为预计值的36.1%（95%置信区间2.4%至69.8%），住院治疗组为35.1%（6.3%至63.9%）。两组在两周（居家护理组42.6%，3.4%至81.8%；住院治疗组42.1%，5.1%至7九1%）和三个月（居家护理组41.5%，8.2%至74.8%；住院治疗组41.9%，6.2%至77.6%）时使用支气管扩张剂后的FEV₁无显著差异。三个月时，接受居家护理的患者中有37%再次入院，接受住院治疗的患者中有34%再次入院。两组在三个月时的死亡率无显著差异（9%对8%）。
对于部分慢性阻塞性肺疾病急性加重期患者，“居家医院”护理是紧急入院治疗的一种切实可行的替代方案。
