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Randomized Controlled Trial
. 2021 Jul;174(7):889-898.
doi: 10.7326/M20-5688. Epub 2021 Apr 20.

Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? : A Randomized Trial

Sasha Shepperd  1 , Chris Butler  1 , Andrea Cradduck-Bamford  1 , Graham Ellis  2 , Alastair Gray  1 , Anthony Hemsley  3 , Pradeep Khanna  4 , Peter Langhorne  5 , Sam Mort  1 , Scott Ramsay  6 , Rebekah Schiff  7 , David J Stott  5 , Angela Wilkinson  8 , Ly-Mee Yu  1 , John Young  9
Affiliations
Randomized Controlled Trial

Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? : A Randomized Trial

Sasha Shepperd et al. Ann Intern Med. 2021 Jul.

Abstract

Background: Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain.

Objective: To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons.

Design: Multisite randomized trial. (ISRCTN registry number: ISRCTN60477865).

Setting: 9 hospital and community sites in the United Kingdom.

Patients: 1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission.

Intervention: Admission avoidance HAH with CGA versus hospital admission with CGA when available using 2:1 randomization.

Measurements: The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction.

Results: Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15]; P = 0.36); 114 of 673 (16.9%) versus 58 of 328 (17.7%) had died (RR, 0.98 [CI, 0.65 to 1.47]; P = 0.92); and 37 of 646 (5.7%) versus 27 of 311 (8.7%) were in long-term residential care (RR, 0.58 [CI, 0.45 to 0.76]; P < 0.001).

Limitation: The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected.

Conclusion: Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons.

Primary funding source: The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66).

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Conflict of interest statement

Conflicts of interests

None declared.

The views expressed are those of the authors and not necessarily those of the National Institute of Health Research or the Department of Health and Social Care.

Figures

Figure 1
Figure 1. CONSORT flow diagram of trial participants
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