Background Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking. Objective To compare outcomes of home hospital versus usual hospital care for patients requiring admission. Design Randomized controlled trial. (ClinicalTrials.gov: NCT03203759). Setting Academic medical center and community hospital. Patients 91 adults (43 home and 48 control) admitted via the emergency department with selected acute conditions. Intervention Acute care at home, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. Measurements The primary outcome was the total direct cost of the acute care episode (sum of costs for nonphysician labor, supplies, medications, and diagnostic tests). Secondary outcomes included health care use and physical activity during the acute care episode and at 30 days. Results The adjusted mean cost of the acute care episode was 38% (95% CI, 24% to 49%) lower for home patients than control patients. Compared with usual care patients, home patients had fewer laboratory orders (median per admission, 3 vs. 15), imaging studies (median, 14% vs. 44%), and consultations (median, 2% vs. 31%). Home patients spent a smaller proportion of the day sedentary (median, 12% vs. 23%) or lying down (median, 18% vs. 55%) and were readmitted less frequently within 30 days (7% vs. 23%). Limitation The study involved 2 sites, a small number of home physicians, and a small sample of highly selected patients (with a 63% refusal rate among potentially eligible patients); these factors may limit generalizability. Conclusion Substitutive home hospitalization reduced cost, health care use, and readmissions while increasing physical activity compared with usual hospital care. Primary Funding Source Partners HealthCare Center for Population Health and internal departmental funds.

中文翻译：

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急性病患者在家中的医院级护理：随机对照试验。

背景技术尽管缺乏来自美国的随机对照试验的证据，但患者家中的替代医院级护理可以降低成本，医疗保健使用和再入院，同时改善患者体验。目的比较需要入院的患者在家中医院治疗与常规医院治疗的结果。设计随机对照试验。（ClinicalTrials.gov：NCT03203759）。设置学术医疗中心和社区医院。患者91名成人（43位家庭患者和48位对照患者）通过急诊室接受了选定的急性病治疗。干预措施在家中进行急性护理，包括护士和医师的家访，静脉内药物治疗，远程监控，视频通信和即时检验。测量主要结果是急性护理发作的总直接费用（非医师人工，用品，药物和诊断测试费用的总和）。次要结果包括急性护理发作期间和第30天的医疗保健使用和体育锻炼。结果家庭患者的急性护理发作调整后平均费用比对照患者低38％（95％CI，24％至49％）。与常规护理患者相比，家庭患者的化验单（每次入院中位数，3比15），影像学检查（中位数，14％比44％）和咨询（中位数，2％比31％）更少。家庭患者在一天的久坐（中位数，分别为12％和23％）或躺卧（中位数，分别为18％和55％）中所占比例较小，并且在30天之内再次入院的频率较低（7％对23％）。局限性该研究涉及2个部位，少量的家庭医生，以及一小部分经过高度筛选的患者（在潜在合格患者中，拒绝率为63％）；这些因素可能会限制泛化性。结论与常规的医院护理相比，替代性的家庭住院治疗降低了成本，减少了医疗保健的使用和重新住院，同时增加了身体活动。主要资金来源合作伙伴卫生保健人口健康中心和内部部门资金。