Hospital at Home Versus Inpatient Care: Costs and Effectiveness
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 200
- 试验地点
- 1
- 主要终点
- Costs
研究概览
简要总结
Background and Objectives Hospital at Home (HaH) delivers hospital-level treatment to acutely ill patients in their own homes, including daily medical and nursing visits, infusions, physiotherapy, and diagnostics. It bridges inpatient and outpatient care, working closely with hospitals, office-based physicians, home care services (Spitex), and therapy providers.
There are two main pathways:
Admission Avoidance: stable patients requiring hospitalization are admitted directly to HaH instead of an inpatient ward.
Early Supported Discharge: patients treated in hospital are discharged earlier than usual and transferred to HaH.
Evidence International studies show HaH to be safe and effective. Reviews report comparable mortality and rehospitalization, shorter hospital stays, and cost advantages. Admission avoidance is linked to trends toward lower mortality and costs. Research showed similar mortality but fewer rehospitalizations, longer treatment duration, and reduced risks of institutionalization, depression, and anxiety. HaH patients were older, with reduced daily living activities, yet care costs were on average USD 5,054 lower than inpatient care.
In Switzerland, the mean hospital stay in 2019 was 8 days (acute somatic: 5.2; psychiatry: 33.5).
Study Hypotheses
HaH can be delivered at equal or lower cost than regular hospitalization.
HaH care is safe, with few complications, and yields high patient satisfaction.
Study Objective To demonstrate that hospital-equivalent home treatment of acutely ill patients is effective, appropriate, cost-efficient (according to Swiss WZW criteria), safe, and associated with high satisfaction and low complication rates compared with inpatient care.
Endpoints
Primary: Costs - HaH vs. inpatient care at Hirslanden Clinic, using REKOLE® cost accounting.
Secondary: Mortality, therapy type, monitoring, diagnostics, rehospitalization, complications, satisfaction, patient-reported outcomes, length of stay, referrals to nursing homes, follow-up after discharge, ED visits, rehabilitation referrals, and home care type.
详细描述
- BACKGROUND AND SIGNIFICANCE OF THE STUDY
The Hospital at Home concept enables hospital-equivalent treatment of acutely ill patients requiring hospitalization in their own homes. Treatment is carried out as in a regular hospital, with daily visits by physicians and nurses. In addition to disease management, including infusion therapies, home-based physiotherapy and diagnostic procedures such as blood and urine testing, ultrasound, and electrocardiography are provided.
This positions Hospital at Home at the interface between traditional inpatient and outpatient care, complementing the existing services of hospitals, office-based physicians, home care organizations (Spitex), physiotherapy, and occupational therapy through a structured treatment process at the patient's home. Care is not provided in isolation but in cooperation with the aforementioned established institutions.
Two referral pathways into Hospital at Home can be distinguished:
Admission Avoidance: eligible patients in stable general condition with an acute illness that would normally require hospitalization are admitted directly into Hospital at Home instead of inpatient care and treated equivalently at home.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inpatients in the hospital or patients in Hospital at Home care
- •Age ≥ 18 years
- •Admission due to a typical Hospital at Home diagnosis (mild to moderate inflammatory and infectious diseases of the lungs, urinary tract, gastrointestinal tract, heart, and skin; exacerbated chronic obstructive pulmonary disease; exacerbation of chronic heart failure; wounds; bleeding/anemia; dehydration; deterioration of general condition in multimorbid patients; infection-related complications in oncological patients; psychiatric problems including delirium; metabolic or autoimmune diseases; orthopedic patients; pain exacerbations of any cause; palliative patients up to and including terminal situations)
- •Patients without severe cognitive impairment or dysfunction who are capable of providing informed consent and/or completing the questionnaire
- •Patients with sufficient proficiency in written and spoken German and/or English
排除标准
- •Inpatient admission for other reasons
- •Refusal to provide informed consent
结局指标
主要结局
Costs
时间窗: 1 year or until the total of 200 participants are included
Comparison of cost of treatment in Hospital at Home vs. regular hospital ("brick and mortar"). Data will be collected via financal data of both groups, 100 patients from the regular hospital (Klinik Hirslanden Zurich) and 100 patients from Hospital at Home AG (Zollikon)
次要结局
- Effectiveness (clinical outcome)(1 year or until the total of 200 participants are included)
- Effectivness (complications)(1 year or until the total of 200 participants are included)
- Patient satisfaction(1 year or until the total of 200 participants are included)