University of Oxford, Oxford, United Kingdom (S.S., C.B., A.C., A.G., S.M., L.Y.).
University Hospital Monklands, Airdrie, United Kingdom (G.E.).
Ann Intern Med. 2021 Jul;174(7):889-898. doi: 10.7326/M20-5688. Epub 2021 Apr 20.
Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain.
To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons.
Multisite randomized trial. (ISRCTN registry number: ISRCTN60477865).
9 hospital and community sites in the United Kingdom.
1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission.
Admission avoidance HAH with CGA versus hospital admission with CGA when available using 2:1 randomization.
The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction.
Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15]; = 0.36); 114 of 673 (16.9%) versus 58 of 328 (17.7%) had died (RR, 0.98 [CI, 0.65 to 1.47]; = 0.92); and 37 of 646 (5.7%) versus 27 of 311 (8.7%) were in long-term residential care (RR, 0.58 [CI, 0.45 to 0.76]; < 0.001).
The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected.
Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons.
The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66).
在家庭中提供具有综合老年评估（CGA）的医院级护理是应对增加的基于床位的医院护理需求的一种方法，但临床效果尚不确定。
评估具有 CGA 的家庭住院回避医院（HAH）对老年人的临床效果。
多站点随机试验。（ISRCTN 注册号：ISRCTN60477865）。
英国的 9 个医院和社区站点。
1055 名病情不稳定但生理稳定的老年人，他们被转诊接受住院治疗。
接受 CGA 的 HAH 回避入院与在可用时接受 CGA 的医院入院，采用 2:1 随机分组。
主要结局是 6 个月时居家生活。次要结局是新入住长期护理院、死亡、健康状况、谵妄和患者满意度。
参与者的平均年龄为 83.3 岁（SD，7.0）。在 6 个月的随访中，672 名 CGA HAH 组的 528 名（78.6%）参与者与 328 名医院组的 247 名（75.3%）参与者（相对风险 [RR]，1.05 [95% CI，0.95 至 1.15]；=0.36））；673 名中的 114 名（16.9%）与 328 名中的 58 名（17.7%）（RR，0.98 [CI，0.65 至 1.47]；=0.92））死亡；646 名中的 37 名（5.7%）与 311 名中的 27 名（8.7%）（RR，0.58 [CI，0.45 至 0.76]；<0.001））。
研究结果最适用于从医院短期急性评估单元转诊的老年人；谵妄发作可能未被发现。
具有 CGA 的住院回避 HAH 在居家生活的老年人比例以及 6 个月时长期护理院入院率方面，与医院入院具有相似的效果。这种类型的服务可以为选定的老年人提供住院治疗的替代方案。
英国国家卫生研究院健康服务和交付研究计划（12/209/66）。
