Hospital at home for elderly acute patients: a study protocol for a randomised controlled trial

• Published in: BMJ open 2024-05, Vol.14 (5), p.e083372-e083372
• Main Authors: Thomsen, Anne Marie Ladehoff, Tayyari, Nasrin, Duvald, Iben, Kirkegaard, Hans, Obel, Børge, Nielsen, Camilla Palmhøj
• Format: Article
• Language: English
• Subjects: ACCIDENT & EMERGENCY MEDICINE; Aged; Aged, 80 and over; Clinical Trial; Collaboration; Cost-Benefit Analysis; Delirium; Denmark; Emergency medical care; Emergency Service, Hospital; Family physicians; Female; HEALTH ECONOMICS; Health services research; Home Care Services; Home Care Services, Hospital-Based - economics; Home health care; Hospitalization; Hospitals; Humans; Informed consent; Male; Mortality; Municipalities; Older people; Patient Discharge; Patient Readmission - statistics & numerical data; Patients; Pneumonia; Quality of Life; Randomized Controlled Trials as Topic; Vital signs
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-083372

IntroductionThe increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients’ quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients.Methods and analysisA total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge.Ethics and disseminationThe RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system.Trial registration number NCT05360914.