远程医疗控制下的家庭住院比住院治疗的效果更好。

Tele-medicine controlled hospital at home is associated with better outcomes than hospital stay.

机构信息

Faculty of Data and Decision Sciences, Technion-Israel Institute of Technology, Haifa, Israel.

Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Israel.

出版信息

PLoS One. 2024 Aug 19;19(8):e0309077. doi: 10.1371/journal.pone.0309077. eCollection 2024.

DOI:10.1371/journal.pone.0309077

PMID:39159148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11332917/

Abstract

BACKGROUND

Hospital-at-home (HAH) is increasingly becoming an alternative for in-hospital stay in selected clinical scenarios. Nevertheless, there is still a question whether HAH could be a viable option for acutely ill patients, otherwise hospitalized in departments of general-internal medicine.

METHODS

This was a retrospective matched study, conducted at a telemedicine controlled HAH department, being part of a tertiary medical center. The objective was to compare clinical outcomes of acutely ill patients (both COVID-19 and non-COVID) admitted to either in-hospital or HAH. Non-COVID patients had one of three acute infectious diseases: urinary tract infections (UTI, either lower or upper), pneumonia, or cellulitis.

RESULTS

The analysis involved 159 HAH patients (64 COVID-19 and 95 non-COVID) who were compared to a matched sample of in-hospital patients (192 COVID-19 and 285 non-COVID). The median length-of-hospital stay (LOS) was 2 days shorter in the HAH for both COVID-19 patients (95% CI: 1-3; p = 0.008) and non-COVID patients (95% CI; 1-3; p < 0.001). The readmission rates within 30 days were not significantly different for both COVID-19 patients (Odds Ratio (OR) = 1; 95% CI: 0.49-2.04; p = 1) and non-COVID patients (OR = 0.7; 95% CI; 0.39-1.28; p = 0.25). The differences remained insignificant within one year. The risk of death within 30 days was significantly lower in the HAH group for COVID-19 patients (OR = 0.34; 95% CI: 0.11-0.86; p = 0.018) and non-COVID patients (OR = 0.38; 95% CI: 0.14-0.9; p = 0.019). For one year survival period, the differences were significant for COVID-19 patients (OR = 0.5; 95% CI: 0.31-0.9; p = 0.044) and insignificant for non-COVID patients (OR = 0.63; 95% CI: 0.4-1; p = 0.052).

CONCLUSIONS

Care for acutely ill patients in the setting of telemedicine-based hospital at home has the potential to reduce hospitalization length without increasing readmission risk and to reduce both 30 days and one-year mortality rates.

摘要

背景

医院居家（HAH）越来越成为某些临床情况下住院的替代方案。然而，HAH 是否可为其他一般内科住院的急性病患者提供可行的选择仍存在疑问。

方法

这是一项回顾性匹配研究，在远程医疗控制的 HAH 部门进行，该部门是一家三级医疗中心的一部分。目的是比较入住医院或 HAH 的急性病患者（包括 COVID-19 和非 COVID-19）的临床结局。非 COVID-19 患者患有三种急性传染病之一：下尿路感染（UTI）或上尿路感染、肺炎或蜂窝织炎。

结果

分析纳入了 159 名 HAH 患者（64 名 COVID-19 和 95 名非 COVID-19），并与住院患者的匹配样本进行了比较（192 名 COVID-19 和 285 名非 COVID-19）。COVID-19 患者的 HAH 住院时间中位数缩短了 2 天（95%CI：1-3；p = 0.008），非 COVID-19 患者的 HAH 住院时间中位数缩短了 3 天（95%CI：1-3；p < 0.001）。COVID-19 患者（优势比（OR）= 1；95%CI：0.49-2.04；p = 1）和非 COVID-19 患者（OR = 0.7；95%CI；0.39-1.28；p = 0.25）的 30 天内再入院率无显著差异。在一年内，差异仍然不显著。COVID-19 患者（OR = 0.34；95%CI：0.11-0.86；p = 0.018）和非 COVID-19 患者（OR = 0.38；95%CI：0.14-0.9；p = 0.019）的 30 天内死亡率风险在 HAH 组显著降低。对于一年的生存期，COVID-19 患者的差异具有统计学意义（OR = 0.5；95%CI：0.31-0.9；p = 0.044），而非 COVID-19 患者的差异无统计学意义（OR = 0.63；95%CI：0.4-1；p = 0.052）。