Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care.

OBJECTIVE

To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital.

DESIGN

Pragmatic randomised controlled trial.

SETTING

Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people.

SUBJECTS

241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate.

INTERVENTIONS

Patients' received hospital at home care or routine hospital care.

MAIN OUTCOME MEASURES

Patients' quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months.

RESULTS

There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme.

CONCLUSIONS

The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.