Montalto Michael, Lui Benjamin, Mullins Ann, Woodmason Katherine
Epworth Hospital in the Home, 89 Bridge Rd, Richmond, VIC 3121, Australia.
Aust Health Rev. 2010 Aug;34(3):269-75. doi: 10.1071/AH09771.
Hospital in the Home (HIH) research is characterised by small samples in new programs. We sought to examine a large number of consecutive HIH admissions over many years in an established, medically-managed HIH service in to determine whether: (1) HIH is a safe and effective method of delivering acute hospital care, under usual operating conditions in an established unit; and (2) what patient, condition and treatment variables contribute to a greater risk of failure.
A survey of all patients admitted to a medically-managed HIH unit from 2000-2007.
A total of 3423 admissions to HIH were examined. Of these 2207 (64.5%) were admitted directly into the HIH from Emergency Department or rooms, with the remainder admitted from hospital wards. A total of 26,653 HIH bed days were delivered. with a mean of 9.3 nursing visits and 4.1 medical visits per admission. A total of 143 patients (4.2%) required an interruption via an unplanned return to hospital; 106(3.1%) did not subsequently return to HIH. The commonest reason for unplanned returns to hospital were: no clinical improvement; cardiac conditions; fevers; breathlessness and pain. Patients over the age of 50, and those receiving intravenous antibiotic therapy, were more likely to require a return to patients died unexpected mortality rate of 0.15%.
This sample of HIH patients is five time the number of HIH patients ever enrolled in randomised trials studies of this area. Further, outcomes were achieved in 'ordinary' working conditions over a long time period. Care was completed without interruption (return to hospital) in 95.8% of all episodes. Interruption was associated with patients referred from impatient wars, older patients who were treated with intravenous antibiotics, Patients referred from Emergency Departments experienced fewer interruptions. Nursing home residents were no more likely to required an interruption to their HIH care.
家庭医院（HIH）研究的特点是新项目中的样本量较小。我们试图对一个成熟的、由医学管理的HIH服务机构多年来大量连续的HIH入院病例进行研究，以确定：（1）在一个成熟单位的常规操作条件下，HIH是否是提供急性医院护理的一种安全有效的方法；（2）哪些患者、病情和治疗变量会导致更高的失败风险。
对2000年至2007年入住由医学管理的HIH单位的所有患者进行调查。
共检查了3423例HIH入院病例。其中2207例（64.5%）从急诊科或病房直接入住HIH，其余从医院病房转入。共提供了26653个HIH床日，每次入院平均有9.3次护理访视和4.1次医疗访视。共有143名患者（4.2%）需要通过意外返回医院而中断治疗；106名（3.1%）随后未返回HIH。意外返回医院的最常见原因是：无临床改善；心脏疾病；发热；呼吸急促和疼痛。50岁以上的患者以及接受静脉抗生素治疗的患者更有可能需要返回医院，患者意外死亡率为0.15%。
该HIH患者样本量是该领域随机试验研究中纳入的HIH患者数量的五倍。此外，在“普通”工作条件下经过长时间取得了结果。95.8%的所有病例护理均未中断（返回医院）。中断与从非住院病房转诊的患者、接受静脉抗生素治疗的老年患者有关，从急诊科转诊的患者中断较少。养老院居民接受HIH护理时中断的可能性并不更高。
