Tibaldi Vittoria, Isaia Gianluca, Scarafiotti Carla, Gariglio Federico, Zanocchi Mauro, Bo Mario, Bergerone Serena, Ricauda Nicoletta Aimonino
Department of Medical and Surgical Disciplines, Geriatric Section, San Giovanni Battista Hospital, Corso Bramante 88/90, 10126 Torino, Italy.
Arch Intern Med. 2009 Sep 28;169(17):1569-75. doi: 10.1001/archinternmed.2009.267.
Although the hospital is the standard venue for short-term medical care, it may be hazardous for older persons. This study was performed to evaluate the feasibility and effectiveness of a physician-led hospital-at-home service for selected elderly patients with acute decompensation of chronic heart failure (CHF).
Prospective, single-blind, randomized controlled trial with 6-month follow-up for patients 75 years or older admitted to the hospital from April 1, 2004, through April 31, 2005, for acute decompensation of CHF. Patients were randomly assigned to the general medical ward (n = 53) or to the Geriatric Home Hospitalization Service (GHHS; n = 48). The GHHS provides diagnostic and therapeutic treatments by hospital health care professionals in the home of the patient.
Patient mortality at 6 months was 15% in the total sample, without significant differences between the 2 settings of care. The number of subsequent hospital admissions was not statistically different in the 2 groups, but the mean (SD) time to first additional admission was longer for the GHHS patients (84.3 [22.2] days vs 69.8 [36.2] days, P = .02). Only the GHHS patients experienced improvements in depression, nutritional status, and quality-of-life scores.
Substitutive hospital-at-home care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF. This type of care demonstrated clinical feasibility and efficacy in comparison with its alternative. Trial Registration clinicaltrials.gov Identifier: NCT00623571.
尽管医院是短期医疗护理的标准场所，但对老年人来说可能存在风险。本研究旨在评估由医生主导的居家医院服务对选定的慢性心力衰竭（CHF）急性失代偿老年患者的可行性和有效性。
对2004年4月1日至2005年4月31日因CHF急性失代偿入院的75岁及以上患者进行前瞻性、单盲、随机对照试验，并随访6个月。患者被随机分配到普通内科病房（n = 53）或老年居家住院服务组（GHHS；n = 48）。GHHS由医院医护人员在患者家中提供诊断和治疗。
总样本中6个月时的患者死亡率为15%，两种护理环境之间无显著差异。两组后续住院次数在统计学上无差异，但GHHS患者首次再次入院的平均（标准差）时间更长（84.3 [22.2]天对69.8 [36.2]天，P = 0.02）。只有GHHS患者的抑郁、营养状况和生活质量评分有所改善。
对于急性失代偿CHF的老年患者，替代性居家医院护理是传统医院住院护理的可行替代方案。与替代方案相比，这种护理方式显示出临床可行性和有效性。试验注册clinicaltrials.gov标识符：NCT00623571。
