Hospital at home provides equivalent results at lower cost for mild COPD exacerbations

Reference

Echevarria C, Gray J, Hartley T, et al. Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation. Thorax 2018;73(8):713-722.

Synopsis

The DECAF score is a well-validated way to risk-stratify patients with a COPD exacerbation. This study identified 120 patients (35 years or older with at least 10 pack-years of smoking) who were admitted for a relatively low-risk COPD exacerbation (DECAF score 0 or 1). Patients were randomized within 24 hours of admission to receive either continued hospitalization or to "hospital at home." The latter consisted of twice-daily nurse visits; as needed physician consultation by phone; and full therapy, including oxygen, respiratory therapy, intravenous drugs, and social and psychological support, as needed. The patients' mean age was 70 years, and 31% were women. At 90 days, there was only 1 death in each arm. The mean length of hospital stay was much lower in the hospital-at-home group (1.2 vs 4.1 days) with no increase in the likelihood of hospital readmission or return visits to the clinic or emergency department. Care was also more cost-effective with hospital at home.