- Design
- Prospective non-randomised controlled pilot trial
- Population
- 144 homebound older adults with acute infections (83 hospital at home, 61 inpatient)
- Primary outcome
- Remission or completed treatment, escalation, death in episode and 30-day mortality
- Effect
- Remission 86.7% vs 95.1% (P=0.153); mortality 2.4% vs 3.3%; stay 9.72 vs 11.85 days (P=0.035)
This prospective, non-randomised controlled pilot compared hospital-level acute care at home with inpatient care in 144 homebound older adults with acute infections needing hospital treatment, across 5 hospitals and 13 community clinics. Participants were generally frail, chronically ill and functionally dependent. The home group (83) had interprofessional visits, intravenous therapy, point-of-care diagnostics and remote monitoring.
Remission or completed treatment was achieved in 86.7% at home and 95.1% in hospital (P=0.153). Mortality during the treatment episode was 2.4% vs 3.3%. Nine home patients (10.8%) needed escalation. Length of stay was shorter at home (9.72 vs 11.85 days; P=0.035), and satisfaction was higher.
Allocation was not randomised, so differences in who chose home care could explain part of the findings. The authors present this as feasibility and acceptability evidence, in a health system with an existing home-care infrastructure.
- Roughly one in ten home patients needed escalation to hospital, so plan a transfer pathway.
- Remission and mortality did not differ significantly between settings in this small pilot.
- Hospital-at-home depends on interprofessional visits, point-of-care diagnostics and remote monitoring.
- Do not extrapolate to settings without those services.
Why it matters
It tests whether acute infection care in frail older adults can move out of hospital without losing safety.
Don't overread it
A non-randomised pilot with 144 patients shows feasibility, not that home care is as safe as admission.
The statistics, in plain English
The remission gap (86.7% vs 95.1%) was not statistically significant, but with 144 participants the trial could not rule out a real difference of that size. A shorter stay with P=0.035 is a modest signal in a non-randomised comparison.
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