Hernandez Carme, Tukpah Ann-Marcia C, Mitchell Henry M, Rosario Nicole A, Boxer Robert B, Morris Charles A, Schnipper Jeffrey L, Levine David M
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA; Home Hospitalization, Medical and Nursing Direction, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Chest. 2023 Apr;163(4):891-901. doi: 10.1016/j.chest.2022.11.006. Epub 2022 Nov 11.
Home hospital (HH) care is hospital-level substitutive care delivered at home for acutely ill patients who traditionally would be cared for in the hospital. Despite HH care programs operating successfully for years and scientific evidence of similar or better outcomes compared with bricks-and-mortar care, HH care outcomes in the United States for respiratory disease have not been evaluated.
Do outcomes differ between patients admitted to HH care with acute respiratory illness vs those with other acute general medical conditions?
This was a retrospective evaluation of prospectively collected data of patients admitted to HH care (2017-2021). We compared patients requiring admission with respiratory disease (asthma exacerbation [26%], acute exacerbation of COPD [33%], and non-COVID-19 pneumonia [41%]) to all other patients admitted to HH care. During HH care, patients received two nurse and one physician visit daily, IV medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. Main outcomes were acute and postacute health care use and safety.
We analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age, 68 ± 17 years, 62% women, and 48% White. Patients with respiratory disease more often were active smokers (21% vs 9%; P < .001). Eighty percent of patients showed an FEV to FVC ratio of ≤ 70; 28% showed a severe or very severe obstructive pattern (n = 118). During HH care, patients with respiratory disease showed less health care use: length of stay (mean, 3.4 vs 4.6 days), laboratory orders (median, 0 vs 2), IV medication (43% vs 73%), and specialist consultation (2% vs 7%; P < .001 for all). Ninety-six percent of patients completed the full admission at home with no mortality in the respiratory group. Within 30 days of discharge, both groups showed similar readmission, ED presentation, and mortality rates.
HH care is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.
居家医院（HH）护理是为急性病患者提供的医院级替代护理，这些患者传统上需在医院接受治疗。尽管HH护理项目已成功运行多年，且有科学证据表明其与实体医院护理相比有相似或更好的效果，但美国针对呼吸系统疾病的HH护理效果尚未得到评估。
因急性呼吸道疾病入院接受HH护理的患者与因其他急性普通内科疾病入院的患者的护理效果是否存在差异？
这是一项对前瞻性收集的HH护理患者数据（2017 - 2021年）的回顾性评估。我们将因呼吸系统疾病入院的患者（哮喘加重[26%]、慢性阻塞性肺疾病急性加重[33%]和非新冠病毒肺炎[41%]）与所有其他接受HH护理的患者进行了比较。在HH护理期间，患者每天接受两次护士和一次医生查房、静脉用药、高级呼吸治疗以及持续的心率和呼吸频率监测。主要结局指标为急性和亚急性医疗保健利用情况及安全性。
我们分析了1031例患者；24%因呼吸系统疾病入院。有呼吸系统疾病和无呼吸系统疾病的患者相似：平均年龄68±17岁，62%为女性，48%为白人。呼吸系统疾病患者中经常吸烟者更多（21%对9%；P <.001）。80%的患者第一秒用力呼气容积与用力肺活量比值≤70；28%表现为重度或极重度阻塞模式（n = 118）。在HH护理期间，呼吸系统疾病患者的医疗保健利用较少：住院时间（平均3.4天对4.6天）、实验室检查医嘱（中位数0对2）、静脉用药（43%对73%）以及专科会诊（2%对7%；所有P <.001）。96%的患者在家中完成了全部住院治疗，呼吸系统疾病组无死亡病例。出院后30天内，两组的再入院率、急诊就诊率和死亡率相似。
HH护理对急性呼吸系统疾病患者与对其他急性普通内科疾病患者一样安全有效。如果扩大规模，它可为卫生系统和社区创造显著高价值的医疗服务能力，并提供提升护理复杂性的机会。
