Hospital at Home admission avoidance with comprehensive geriatric assessment to maintain living at home for people aged 65 years and over: a RCT

• DOI: 10.3310/htaf1569
• Publication Date: 2022-02-01T14:59:52Z
• Authors: Sasha Shepperd; Andrea Cradduck-B...; Christopher Butler; Graham Ellis; Mary Godfrey; Alastair Gray; Anthony Hemsley; Pradeep Khanna; Peter Langhorne; Petra Mäkelä; Sam Mort; Scott Ramsay; Rebekah Schiff; Surya Singh; Susan Smith; David J Stott; Apostolos Tsiachr...; Angela Wilkinson; Ly-Mee Yu; John Young
• Keywords: Hospital admission; Acute care

Background Evidence is required to guide the redesign of health care for older people who require hospital admission. Objectives We assessed clinical effectiveness and cost-effectiveness geriatrician-led admission avoidance at home with comprehensive geriatric assessment, experiences their caregivers, how services differed. Design A multisite, randomised, open trial assessment home, compared hospital, using a 2 : 1 (hospital hospital) ratio, parallel economic process evaluation. Participants were randomised secure online system. Setting recruited from primary or acute units nine sites across UK. Older because an change in health. Intervention Geriatrician-led assessment. Main outcome measures The main outcome, ‘living home’ (the inverse death living residential setting), was measured 6-month follow-up. Secondary outcomes 6 months incidence delirium, mortality, new long-term care, cognitive impairment, ability perform activities daily living, quality-adjusted survival, length stay transfer hospital. 12 mortality. Results allocated ( n = 700) 355). All reported relative risks (RRs) adjusted are There no significant differences between groups proportions patients [528/672 (78.6%) vs. 247/328 (75.3%), RR 1.05, 95% confidence interval (CI) 0.95 1.15; p 0.36] [443/670 (66.1%) 219/325 (67.4%), 0.99, CI 0.89 1.10; 0.80]; mortality [114/673 (16.9%) 58/328 (17.7%), 0.98, 0.65 1.47; 0.92] [188/670 (28.1%) 82/325 (25.2%), 1.14, 0.80 1.62]; proportion impairment [273/407 (67.1%) 115/183 (62.8%), 1.06, 0.93 1.21; 0.36]; as by Barthel Index (mean difference 0.24, –0.33 0.80; 0.411; 521 contributed data; 256 data) Comorbidity (adjusted mean 0.0002, –0.15 0.15; 0.10; 474 227 months. varying denominator reflects number participants data different outcomes. reduction [37/646 (5.7%) 27/311 (8.7%), 0.58, 0.45 0.76; < 0.001] [39/646 (6.0%) 0.61, 0.46 0.82; 0.001], risk delirium month [10/602 (1.7%) 13/295 (4.4%), 0.38, 0.19 0.006] increased [173/672 (25.7%) 64/330 (19.4%), 1.32, 1.06 1.64; 0.012], but not [343/631 (54.40%) 171/302 (56.6%), 0.95, 0.86 1.06; 0.40]. Patient satisfaction favour home. An unexpected adverse event that might have been related research Research Ethics Committee. At months, there NHS, personal social informal costs –£3017, –£5765 –£269), survival. caregivers played crucial role supporting delivery care. In this included monitoring patient’s managing transitional arrangements. Limitations findings most applicable referred unit. Conclusions Comprehensive can provide cost-effective alternative hospitalisation selected people. Further includes stronger element carer support generate evidence improve Trial registration This registered ISRCTN60477865. Funding project funded National Institute Health (NIHR) Social Care Delivery programme will be published full ; Vol. 10, No. 2. See NIHR Journals Library website further information.