1. Comprehensive geriatric assessment at home was shown to have no difference in the proportion of participants living at home compared to bed-based hospital care at six months of follow-up.
2. Comprehensive geriatric assessment at home was shown to decrease admission for long-term residential care compared to bed-based hospital care.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Out-of-hospital care is often desired by both healthcare providers and elderly patients due to cost, availability, and minimizing exposure to health risks. However, there is a gap in knowledge as to whether hospital-at-home (HAH) care with comprehensive geriatric assessment (CGA) improves the health outcomes of older persons. This study evaluated the effects of HAH care with CGA compared with inpatient care with CGA. This study found no difference in the proportion of participants living at home after six months in the HAH with the CGA group and the hospitalization group. Furthermore, there was a relative decrease in admission for long-term residential care for participants in the HAH with the CGA group compared to the hospitalized group. This study was limited by the potential bias of participants being aware of their study group assignment. Nonetheless, these study’s findings are significant, as they demonstrated avoidance of hospitalization had similar outcomes compared to hospital admission, which can aid hospitals in providing additional healthcare options for older persons referred for hospitalization.
Relevant Reading: Hospital at Home for Older Patients With Underlying Comorbidity
In-Depth [randomized control study]: This randomized control study studied 1055 participants from nine sites in the United Kingdom. Participants who were over 65 years old, able to give informed consent, and referred to HAH service with CGA were included in this study. Patients with a previous history of acute coronary syndrome or who were considered too high risk for home-based care were excluded from the study. The participants were randomized in a 2:1 ratio into either HAH with CGA or hospitalization, respectively. The primary outcome was living at home at six months of follow-up. Outcomes in the primary analysis were assessed with a log-Poisson generalized linear mixed-effects model and predicted probabilities were calculated. Among the two groups, there was no evidence of a difference in living at home at six months of follow up (relative risk [RR], 1.05; 95% confidence interval [CI], 0.95 to 1.15; P = 0.36) or at 12 months (RR, 0.99, 95% CI, 0.89 to 1.10; P = 0.80). Additionally, there was a significant decrease in long-term residential care in the CGA HAH group at six-months of follow up (RR, 0.58; 95% CI, 0.45 to 0.76; P < 0.001) and 12 months (RR, 0.61, 95% CI, 0.46 to 0.82; P < 0.001). There was also no evidence of a difference in risk for cognitive impairment between both groups (RR, 1.06; 95% CI, 0.93 to 1.21; P < 0.36). Overall, the study determined for older patients often referred for hospitalization, similar outcomes occur for those who receive care at home through HAH CGA compared with hospital admission.
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