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Hospital at Home schemes are cost effective and preferred by COPD patients

People who have had a COPD exacerbation can be safely and cost effectively cared for in 'Hospital at Home' schemes, reports a NIHR (National Institute for Health Research) - funded study.

They can also be discharged from hospital more quickly if they are rated as low risk on the DECAF clinical scoring system, which predicts the mortality of patients hospitalised with a COPD exacerbation.

Patients prefer to be cared for at home rather than being admitted to hospital, say the researchers.

This randomised controlled trial included 120 people admitted to three hospitals in England with a COPD exacerbation who had a low risk DECAF score of 0 or 1. Patients were assigned to either stay in hospital or have the ‘Hospital at Home’ service.

People receiving Hospital at Home were visited by a respiratory specialist nurse once or twice a day. A respiratory consultant provided remote supervision. Patients had an emergency number to contact the team at any time and access to physiotherapy, occupational therapy, psychology, pharmacy, and short-term social support.

Patients had daily monitoring of their breathing rate, blood pressure, and blood oxygen levels, with blood tests if needed. Oral and intravenous treatments plus oxygen therapy were available.

Hospital stays were on average four days shorter when people were discharged early to the Hospital at Home scheme, and there was no noticeable increase in readmissions in this group. In 2017–18 in England, there were 34,980 hospital admissions for acute exacerbations of COPD, totalling 137,099 days in hospital.

Dr Noel Baxter PCRS Chair says: “This RCT will provide reassurance to many of our community team members who have been providing hospital at home care for people with COPD exacerbations for many years already that not only is it a preferred option for people to be cared for at home but that with the right selected patient it is also safe for them to be cared for in this way.”

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