Stewart S, Pearson S, Luke C G, Horowitz J D
Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Woodville, South Australia.
J Am Geriatr Soc. 1998 Feb;46(2):174-80. doi: 10.1111/j.1532-5415.1998.tb02535.x.
To determine the effect of a home-based intervention (HBI) on the frequency of unplanned readmission and out-of-hospital death among patients discharged home from acute hospital care.
A randomized controlled trial comparing HBI with usual care (UC).
A tertiary referral hospital servicing the northwestern region of Adelaide, South Australia.
Medical and surgical patients (n = 762) discharged home after hospitalization.
Home-based intervention (n = 381) consisted of counseling of all patients before discharge followed by a single home visit (by a nurse and pharmacist) to those patients considered to be at high risk of readmission (n = 314) in order to optimize compliance with and knowledge of the treatment regimen, identify early clinical deterioration, and intensify follow-up of such patients where appropriate.
The primary endpoint was the number of unplanned readmissions plus out-of-hospital deaths over a 6-month follow-up period.
During the study follow-up, the major endpoint occurred most commonly in the UC group (217 vs 155 episodes: P < .001). Overall, the HBI group demonstrated fewer unplanned readmissions (154 vs 197: P = .022), out-of-hospital deaths (1 vs. 20: P < .001), total deaths (12 vs. 29: P = .006), emergency department attendances (236 vs 314: P < .001), and total days of hospitalization (1452 vs 1766: P < .001). There was a disproportionate reduction in multiple events among HBI patients (P = .035). Hospital-based costs of health care during study follow-up tended to be lower in the HBI group ($A2190 vs $A2680 per patient: P = .102). Mean cost of HBI was $A190 per patient visited, whereas other community-based health care costs were similar for both groups.
Among high-risk patients discharged from acute hospital care, HBI is beneficial in limiting unplanned readmissions and reducing risk of out-of-hospital death. It may be particularly cost-effective if applied selectively to patients with a history of frequent unplanned hospital admission.
确定家庭干预（HBI）对急性医院护理后出院回家患者的非计划再入院频率和院外死亡的影响。
一项将HBI与常规护理（UC）进行比较的随机对照试验。
为南澳大利亚阿德莱德西北部地区服务的一家三级转诊医院。
住院后出院回家的内科和外科患者（n = 762）。
家庭干预（n = 381）包括在出院前对所有患者进行咨询，然后对那些被认为再入院风险高的患者（n = 314）进行一次家访（由护士和药剂师进行），以优化对治疗方案的依从性和了解程度，识别早期临床恶化情况，并在适当情况下加强对此类患者的随访。
主要终点是6个月随访期内非计划再入院次数加院外死亡次数。
在研究随访期间，主要终点最常发生在UC组（217次事件对155次事件：P <.001）。总体而言，HBI组的非计划再入院次数较少（154次对197次：P =.022），院外死亡次数较少（1次对20次：P <.001），总死亡次数较少（12次对29次：P =.006），急诊就诊次数较少（236次对314次：P <.001），住院总天数较少（1452天对1766天：P <.001）。HBI患者中多项事件的减少不成比例（P =.035）。研究随访期间，HBI组基于医院的医疗保健成本往往较低（每位患者2190澳元对2680澳元：P =.102）。接受家访的每位患者的HBI平均成本为190澳元，而两组基于社区的其他医疗保健成本相似。
在急性医院护理后出院的高危患者中，HBI有助于限制非计划再入院并降低院外死亡风险。如果选择性地应用于有频繁非计划住院史的患者，可能具有特别的成本效益。
