Medical model for hospital in the home: effects on patient management

Abstract

Objective: To evaluate the effects of a change to a medical model for hospital in the home (HITH). Design and setting: This was a retrospective pre- and post-intervention study in the Royal Melbourne Hospital HITH between 28 March 2002 and 29 March 2006. The intervention was daily review, by medical staff, of all patients in their homes. 159 patients with cellulitis or deep venous thrombosis (DVT) admitted to HITH in the preintervention period were matched with patients admitted in the post-intervention period. Main outcome measures: HITH length of stay (LOS), scheduled and unscheduled hospital review rates (during the HITH admission), and hospital admission rates. Results: Post-intervention, median LOS decreased (6 v 5 days [P= 0.03]). There were also significant reductions in scheduled and unscheduled review rates (40.9 v 1.3 reviews/100 patients [P< 0.001] and 15.7 v 4.4 reviews/100 patients [P= 0.001], respectively) and hospital admission rates (10.7 v 3.8 admissions/100 patients [P= 0.02]). Although there was no difference in adverse event rates between the two periods (3.1 v 2.5/100 patients [P= 0.50]), there was a significantly greater complication rate post-intervention (57.2 v 92.4/100 patients [P< 0.001]). Conclusion: The medical model resulted in significant improvements in process measures and clinical endpoints among patients with cellulitis and DVT.