Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Am Geriatr Soc. 2020 Jul;68(7):1579-1583. doi: 10.1111/jgs.16486. Epub 2020 May 6.
BACKGROUND/OBJECTIVES: Hospital at home (HaH) provides interdisciplinary acute care in the home as a substitute for inpatient hospitalization. Studies have demonstrated that HaH care is associated with better quality care, fewer complications, and better patient and caregiver experience. Still, some patients decline HaH. The objective of the study was to characterize patients who accept vs decline HaH care and describe reasons for their decisions in the context of a Center for Medicare and Medicaid Innovation demonstration of HaH.
DESIGN/SETTING/PARTICIPANTS: A total of 442 patients with Medicare or other eligible insurance, 18 years or older, who met study eligibility criteria were offered HaH at Mount Sinai Hospitals in New York, NY, between September 1, 2014, and August 31, 2017.
Reasons for accepting or declining HaH were recorded. Age, sex, insurance type, and admission diagnoses of HaH acceptors and refusers were compared in univariate analyses.
Of the 442 patients offered HaH, 66.7% accepted. Main reasons for enrolling in HaH included being more comfortable at home (78.2%) and being near family (40.7%). Specific reasons given for refusing HaH included preferring in-hospital care (15.0%) and concern that HaH would not meet care needs (12.9%).
Two-thirds of patients offered HaH care opted to receive it. The reasons for declining HaH provided by those who chose not to participate should be considered for quality improvement, and reasons for acceptance may be helpful in marketing and other efforts to promote HaH participation. J Am Geriatr Soc 68:1579-1583, 2020.
背景/目的：医院居家（HaH）提供家庭内的跨学科急性护理，作为住院治疗的替代。研究表明，HaH 护理与更好的护理质量、更少的并发症以及更好的患者和护理人员体验相关。尽管如此，仍有一些患者拒绝接受 HaH 护理。本研究的目的是描述接受和拒绝 HaH 护理的患者特征，并在 Medicare 和 Medicaid Innovation 中心对 HaH 护理进行示范的背景下，描述他们做出决策的原因。
设计/环境/参与者：2014 年 9 月 1 日至 2017 年 8 月 31 日，在纽约西奈山医院，共对 442 名符合条件的 Medicare 或其他合格保险、18 岁或以上的患者提供 HaH。
记录接受或拒绝 HaH 的原因。对 HaH 接受者和拒绝者的年龄、性别、保险类型和 HaH 入院诊断进行单变量分析。
在提供 HaH 的 442 名患者中，有 66.7%的患者接受了 HaH。选择接受 HaH 的主要原因包括在家更舒适（78.2%）和接近家人（40.7%）。拒绝 HaH 的具体原因包括更喜欢住院治疗（15.0%）和担心 HaH 无法满足护理需求（12.9%）。
接受 HaH 护理的患者中有三分之二选择接受 HaH。对于那些选择不参与的人拒绝 HaH 的原因，应考虑进行质量改进，而接受 HaH 的原因可能有助于营销和其他促进 HaH 参与的努力。
美国老年学会杂志 68：1579-1583，2020 年。
