Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? A Randomized Trial
Study of 1055 older persons (mean age 83.3 years, medically unwell, physiologically stable at 9 hospital and community sites in UK) found admission avoidance with hospital at home with comprehensive geriatric assessment led to similar outcomes as hospital admission at 6 months
Source:
Annals of Internal Medicine
SPS commentary:
At 6-month follow-up, 528 of 672 (78.6%) in the Comprehensive Geriatric Assessment Hospital at Home group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk 1.05; 95% CI, 0.95 to 1.15; p = 0.36).
According to an editorial, there were some significant challenges to the design of this trial that should be noted. Although a randomised trial was planned, 22% of those randomly assigned to hospitalisation either declined hospital admission and received Hospital at Home (HAH) services or were diverted to HAH because of issues with bed capacity. This, it suggests, tempers confidence in the study's findings because it represents more of a real-world evaluation than a controlled experiment. In addition, the primary outcome of living at home at 6 months may be more of a reflection of the Comprehensive Geriatric Assessment (CGA) than of the single HAH admission for acute care. It notes the observation that participants in the HAH group had a 32% increased likelihood of admission to the hospital in the month after HAH admission suggests that further support to older patients beyond the brief HAH episode could prevent readmission. It adds that the most distinctive feature of this study compared with others of HAH is the addition of CGA and further study of the value of combining this with HAH as a strategy to improve outcomes among older patients requiring acute hospital-level care is warranted.