Satisfaction with Hospital at Home Care

• Published in: Journal of the American Geriatrics Society (JAGS) 2006-09, Vol.54 (9), p.1355-1363
• Main Authors: Leff, Bruce, Burton, Lynda, Mader, Scott, Naughton, Bruce, Burl, Jeffrey, Clark, Rebecca, Greenough III, William B., Guido, Susan, Steinwachs, Donald, Burton, John R.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Attitude surveys; Biological and medical sciences; Caregivers - psychology; Cellulitis - therapy; chronic care; Comparative studies; Female; Follow-Up Studies; General aspects; Health Care Surveys; Heart Failure - therapy; Home Care Services, Hospital-Based; Home health care; hospital at home; Hospitalization; Humans; Inpatient care; Lung Diseases - therapy; Male; Medical sciences; Miscellaneous; Patient Satisfaction; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; quality of care; satisfaction with care; Treatment Outcome
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2006.00855.x

OBJECTIVES: To examine differences in satisfaction with acute care between patients who received treatment in a physician‐led substitutive Hospital at Home program and those who received usual acute hospital care. DESIGN: Survey questionnaire of participants in prospective, nonrandomized clinical trial. SETTING: Three Medicare‐managed care health systems and a Department of Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community‐dwelling elderly patients who required acute hospital admission for community‐acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in Hospital at Home and 130 in the acute care hospital. INTERVENTION: Treatment in a Hospital at Home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS: A 40‐question survey measuring nine domains of care for patients and a 37‐question survey measuring eight domains of care for family members. RESULTS: A higher proportion of patients were satisfied with treatment in Hospital at Home than with the acute care hospital in eight of nine domains, and this difference was statistically different in four domains. Hospital at Home patients were more likely than acute hospital patients to be satisfied with their physician (adjusted odds ratio (AOR)=3.84, 95% confidence interval (CI)=1.32–11.19), comfort and convenience of care (AOR=6.52, 95% CI=1.97–21.56), admission processes (AOR=5.90, 95% CI=2.21–5.76), and the overall care experience (AOR=2.98, 95% CI=1.08–8.21). Family members of patients treated in Hospital at Home were also more likely to be satisfied with multiple domains of care. CONCLUSION: Hospital at Home care was associated with greater satisfaction than acute hospital inpatient care for patients and their family members. These findings support further dissemination of the Hospital at Home care model.