Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

ACCESS, an open-labelled randomised clinical trial of effectiveness

Christian Backer Mogensen, Ejnar Skytte Ankersen, Mats J Lindberg, Stig L Hansen, Jørgen Solgaard, Pia Therkildsen, Helene Skjøt-Arkil

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient's recovery or number of deaths.

METHODS: Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests.

RESULTS: Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45% in the hospital specialist arm versus 24% in the GP arm were admitted within 7 days (effect size 2.7, 95% CI 1.3-5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0-7 days between the two groups.

CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models.

REGISTRATION: No. NCT02422849 Registered 27 March 2015. Retrospectively registered.

OriginalsprogEngelsk
Artikelnummer26
TidsskriftScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Vol/bind26
Udgave nummer1
Antal sider8
ISSN1757-7241
DOI
StatusUdgivet - 5. apr. 2018

Fingeraftryk

General Practitioners
Randomized Controlled Trials
Patient Admission
Denmark
Home Care Services
Hospital Emergency Service

Citer dette

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title = "Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness",
abstract = "BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient's recovery or number of deaths.METHODS: Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests.RESULTS: Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45{\%} in the hospital specialist arm versus 24{\%} in the GP arm were admitted within 7 days (effect size 2.7, 95{\%} CI 1.3-5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0-7 days between the two groups.CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models.REGISTRATION: No. NCT02422849 Registered 27 March 2015. Retrospectively registered.",
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Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model : ACCESS, an open-labelled randomised clinical trial of effectiveness. / Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J; Hansen, Stig L; Solgaard, Jørgen; Therkildsen, Pia; Skjøt-Arkil, Helene.

I: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Bind 26, Nr. 1, 26, 05.04.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

T2 - ACCESS, an open-labelled randomised clinical trial of effectiveness

AU - Mogensen, Christian Backer

AU - Ankersen, Ejnar Skytte

AU - Lindberg, Mats J

AU - Hansen, Stig L

AU - Solgaard, Jørgen

AU - Therkildsen, Pia

AU - Skjøt-Arkil, Helene

PY - 2018/4/5

Y1 - 2018/4/5

N2 - BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient's recovery or number of deaths.METHODS: Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests.RESULTS: Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45% in the hospital specialist arm versus 24% in the GP arm were admitted within 7 days (effect size 2.7, 95% CI 1.3-5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0-7 days between the two groups.CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models.REGISTRATION: No. NCT02422849 Registered 27 March 2015. Retrospectively registered.

AB - BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient's recovery or number of deaths.METHODS: Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests.RESULTS: Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45% in the hospital specialist arm versus 24% in the GP arm were admitted within 7 days (effect size 2.7, 95% CI 1.3-5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0-7 days between the two groups.CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models.REGISTRATION: No. NCT02422849 Registered 27 March 2015. Retrospectively registered.

KW - Community

KW - Elderly

KW - General practitioner

KW - Hospital

KW - Hospital specialist

KW - Hospital-at-home

U2 - 10.1186/s13049-018-0492-3

DO - 10.1186/s13049-018-0492-3

M3 - Journal article

VL - 26

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

SN - 1757-7241

IS - 1

M1 - 26

ER -