- Design
- Prospective, non-randomised controlled pilot
- Population
- 144 frail homebound older adults with acute infection
- Primary outcome
- Remission, escalation, death during episode, 30-day mortality
- Effect
- Remission 86.7% vs 95.1% (p = 0.153); LOS 9.7 vs 11.9 days
A prospective, non-randomised controlled pilot in Taiwan compared direct home admission for hospital-level acute care with standard admission in 144 homebound, frail older adults with acute infections across 5 hospitals and 13 community clinics. The home group received interprofessional visits, intravenous treatment, point-of-care testing and remote monitoring.
Remission or completed treatment occurred in 86.7% at home and 95.1% in hospital (p = 0.153), and death during the episode in 2.4% and 3.3%. Nine home patients (10.8%) needed transfer to hospital. Length of stay was shorter at home (9.7 vs 11.9 days) and satisfaction higher.
The groups were not randomised and the sample was small, so the numerically lower remission rate at home cannot be dismissed. The model depends on an established home-care infrastructure that most Indian settings lack, though elements such as home intravenous antibiotics are already used.
- Hospital at home can work for frail patients with infection when escalation to hospital is quick and planned.
- About one in ten home-treated patients needed transfer; build that pathway before starting a service.
- Selection was not randomised, so outcome comparisons are provisional.
- Patient and caregiver satisfaction was consistently higher at home.
Why it matters
For housebound patients, admission itself carries harm, and alternatives are now being tested at scale.
Don't overread it
A small non-randomised pilot cannot show that home care is as effective as hospital care.
The statistics, in plain English
A p-value of 0.153 for remission means the difference between 86.7% and 95.1% could be chance — but in 144 patients the study was too small to rule out a real gap.
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