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This study examines the implications of providing hospital-level care in rural homes.
Full description
Home hospital is hospital-level care at home for acutely ill patients. In multiple publications mostly in urban environments, home hospital care delivered cost-effective, high-quality, excellent experience care with similar quality and safety as traditional hospital care. Most home hospital models deliver care in urban environments, not in rural environments.
To determine the effect of home hospital care in rural homes, the investigators propose to the following randomized control trial.
Enrollment
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Volunteers
Inclusion criteria
Patient clinical inclusion criteria:
Patient environmental inclusion criteria:
Lives in a rural area that can be served by the RHH team.
Has capacity to consent to study OR can assent to study and has proxy who can consent (see subject enrollment, below)
Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient.
Patient caregiver inclusion criteria: (not required for patient participation):
Clinician inclusion criteria:
Sites without continuous monitoring will make amendments to the above inclusion criteria
Exclusion criteria
Patient exclusion clinical criteria:
Acute delirium, as determined by the Confusion Assessment Method
Cannot establish peripheral access by any means
Secondary condition: active non-melanoma/prostate cancer, end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage (unless part of end of life pathway)
Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
Cannot independently ambulate to bedside commode, unless home-based aides are available
As deemed by on-call MD, patient likely to require any of the following procedures that have not already occurred: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery (unless these can be coordinated with appropriate facilities during the home hospitalization)
For pneumonia:
For heart failure:
For complicated urinary tract infection:
For other infection
For COPD
For asthma
o Peak expiratory flow < 50% of normal: exercise caution
For diabetes and its complications
o Requires IV insulin
For hypertensive urgency
For atrial fibrillation with rapid ventricular response
Home hospital census is full
Patient environmental exclusion criteria:
Sites without continuous monitoring will make amendments to the above exclusion criteria
Primary purpose
Allocation
Interventional model
Masking
160 participants in 2 patient groups
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Central trial contact
David M Levine, MD, MPH, MA
Data sourced from clinicaltrials.gov
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