Hospital at Home Versus Inpatient Care: Costs and Effectiveness

Costs

Comparison of cost of treatment in Hospital at Home vs. regular hospital ("brick and mortar"). Data will be collected via financal data of both groups, 100 patients from the regular hospital (Klinik Hirslanden Zurich) and 100 patients from Hospital at Home AG (Zollikon)

Effectiveness (clinical outcome)

Measure of how effective the treatment in Hospital at Home vs. regular hospital ("brick and mortar") is. The clinical outcome will be measured by: Mortality up to 30 days after discharge, emergency-admission up to 30 days after discharge, readmission to the hospital/H@H up to 30 days after discharge, GP-consultation up to 30 days after discharge, specialist-consultation up to 30 days after discharge, admission to nursing home up to 30 days after discharge. Data will be collected through patient data, collected via clinical information system and phone calls to the patient 30 days after discharge.

Effectivness (complications)

Measure of how effective the treatment in Hospital at Home vs. regular hospital ("brick and mortar") is. The clinical outcome will be measured by measuring the number and kind of complication. We will collect data regarding number of falls, (up to 30 days after discharge), number of new infections during treatment, development of bedsores during treatment (yes/no), development of delirium during treatment (yes/no), thrombosis during treatment (yes/no). Data will be collected through patient data, collected via clinical information system and phone calls to the patient 30 days after discharge.

Patient satisfaction

How satisfied are the patients treated in Hospital at Home compared to patients treated in the regular hospital ("brick and mortar"), measured by patient questionnaires. First questionnaire (patient satisfaction) consists of 8 questions each reaching from 0-5 points (0 = worst, 5 = best) regarding overall assessment, recommendation of service, assessment by relatives, competencies of nurses, competencies of doctors, quality of hotline, satisfaction with communication/flow of information and safety. Second questionnaire ist the PROMIS Globla health 10 consisting of 10 questions, first 9 reaching from 1-5, last question reaching from 0-10 points. The questions assess global well-being, quality of life, physical and psychological well-being, satisfaction with level of activity, handling of everyday activities, handling of everyday phsysical tasks, mental problems, tiredness, pain. Data will be collected through patient data, collected via clinical information system and phone calls.

patient data

Data regarding demographics including name, date of birth, age, sex, language, distance hospital to home, date of death, date of admission/discharge, length of stay, ICD-codes, -chapters, major diagnostic chapters, type of insurance, billing, referrer, living situation (alone yes/no), care situation (independent, nursing home), nr of drugs ad admission/30d post discharge, polypharmacy (defined as \>5 drugs at admission), nr of chronic comorbidities, Charlson comorbidity score/-10 year survival rate, cognitive impairment (yes/no), i.v.-medication during treatment (yes/no, duration), monitoring (yes/no, duration), nr of hotline calls/ringing of nurse, nr of doctor/nurses visits, nr of ecg/sonography/xray/expert consultation, yes/no of physiotherapy/O2-substitution. Data will be collected through patient data, collected via clinical information system and phone calls to the patient 30 days after discharge.

result of first blood sample

Collection of results of first blood sample, taken at admission to hospital/H@H. Collection of white blood cell count G/l, hemoglobin g/l, CRP mg/l, natrium mmol/l, potassium mmol/l, creatinine umol/l, GFR ml/min/1.73m2, ALT U/l. Data will be collected through patient data, collected via clinical information system and phone calls to the patient 30 days after discharge.

first vital signs measured at admission

Collection of values of first vital sign measurement at admission. Collection of SpO2 in %, body temperature in °C, blood pressure in mmHg, respiratory rate in x/min. Data will be collected through patient data, collected via clinical information system and phone calls to the patient 30 days after discharge.