Hospital in the Home models of treatment for elderly patients with nursing home-acquired pneumonia (NHAP) are as safe and effective as treatment in hospital, and could reduce the enormous burden of NHAP on the hospital system, according to research published online by the Medical Journal of Australia.
NHAP accounted for 31,760 acute hospital admissions for pneumonia in Australia during 2008-09. Assuming a mean hospital length of stay of 7 days for each patient, NHAP results in 609 permanently occupied hospital beds in Australia, a considerable burden on the system.
The Hospital in the Home (HITH) service of the Royal Melbourne Hospital (RMH) has been operating for 20 years, delivering care to NHAP patients in residential aged care homes on a 24/7 basis. The service is responsible for all acute medical, acute nursing, pathology, radiology and pharmaceutical care for its patients, including the administration of oxygen and intravenous antibiotics and fluids, and also provides pathology and mobile radiology services. Medical staff visit the patient in their home each day, and nurses also visit the resident at least once each day.
Associate Professor Michael Montalto, Unit Head of the RMH HITH service, and his co-authors from the Queen Elizabeth Hospital in Hong Kong, the Victorian Infectious Diseases Service and the Doherty Institute for Infection and Immunity, compared the data of a group of NHAP patients treated at the RMH with a group treated through the HITH program between 1 July 2013 to 31 January 2014.
"There were no adjusted differences in median length of stay between HITH and control patients or in overall mortality at 30 days", the researchers reported. "There were no differences between the two groups with regard to complications (falls and pressure wounds) and 30-day readmission rates.
"[These results] suggest that the HITH model is effective and safe for this group of patients."
Professor Montalto and his colleagues warned that the "proportion of the hospital workload associated with treating RACF patients will only increase.
"HITH may provide a targeted and effective hospital response that can deliver equivalent quality care without extending the patient's length of stay.
"This requires well resourced, intensive, medically based HITH, supported by hospital level technologies, such as intravenous therapies, expert staff and mobile x-ray facilities, as well as the willingness to meet the challenge of switching care models for the high level of disease severity with which these patients inevitably present."