Prolonged effects of a home-based intervention in patients with chronic illness

Pearson, Sue, Inglis, Sally C., McLennan, Skye N., Brennan, Lucy, Russell, Mary, Wilkinson, David, Thompson, David R. and Stewart, Simon (2006) Prolonged effects of a home-based intervention in patients with chronic illness. Archives of Internal Medicine, 166 6: 645-650. doi:10.1001/archinte.166.6.645

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Author Pearson, Sue
Inglis, Sally C.
McLennan, Skye N.
Brennan, Lucy
Russell, Mary
Wilkinson, David
Thompson, David R.
Stewart, Simon
Title Prolonged effects of a home-based intervention in patients with chronic illness
Journal name Archives of Internal Medicine   Check publisher's open access policy
ISSN 0003-9926
Publication date 2006
Sub-type Article (original research)
DOI 10.1001/archinte.166.6.645
Open Access Status File (Publisher version)
Volume 166
Issue 6
Start page 645
End page 650
Total pages 6
Editor P. Greenland
C. D. DeAngelis
Place of publication Chicago, IL, United States
Publisher American Medical Association
Collection year 2006
Language eng
Abstract Background: Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial. Methods: We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, homebased intervention (HBI) (n = 260) or to usual postdischarge care (n = 268). Results: During follow-up, HBI had no impact on all-cause mortality (relative risk, 1.04; 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86-1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean +/- SD rate, 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions/patient per year; P = .08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean +/- SD rate, 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission/patient per year; P =. 04) and by 21% in all surviving patients within 3 to 8 years (mean +/- SD rate, 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions/ patient per year; P =. 03). Overall, recurrent hospital costs were significantly lower ( 14%) in the HBI group (mean +/- SD, $ 823 +/- $ 1642 vs $ 960 +/- $ 1376 per patient per year; P =. 045). Conclusion: This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses, except for chronic obstructive pulmonary disease.
Keyword Medicine, General & Internal
Congestive-heart-failure
Randomized Controlled Trial
Obstructive Pulmonary-disease
Post-acute Hospitalization
Unplanned Readmissions
Elderly People
Older-adults
Management
Care
Multidisciplinary
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 09:07:35 EST