Hospital-Level Care at Home for Acutely Ill Adults
Completed · Not applicable
Conditions studied: Infection, Heart Failure, COPD, Asthma, Gout Flare, Chronic Kidney Diseases, Hypertensive Urgency, Atrial Fibrillation Rapid, Anticoagulants; Increased
In brief
The investigators propose a home hospital model of care that substitutes for treatment in an acute care hospital. Limited studies of the home hospital model have demonstrated that a sizeable proportion of acute care can be delivered in the home with equal quality and safety, reduced cost, and improved patient experience.
Key facts
- Study ID
- NCT03203759
- Run by
- Brigham and Women's Hospital
- People needed
- 91
- Starts
- 2017-06-06
- Expected to finish
- 2018-05-15
- Last updated by the study team
- 2018-08-29
Who can join
Age: 18 and older. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Resides within either a 5-mile or 20 minute driving radius of emergency department
- Has capacity to consent to study OR can assent to study and has proxy who can consent
- >= 18 years-old
- 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. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
- Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.
You may not qualify if…
- Undomiciled
- No working heat (October-April), no working air conditioning if forecast > 80°F (June-September), or no running water
- On methadone requiring daily pickup of medication
- In police custody
- Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
- Domestic violence screen positive
- Acute delirium, as determined by the Confusion Assessment Method
- Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
- Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
- Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
- Cannot independently ambulate to bedside commode
- As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
- High risk for clinical deterioration
- Home hospital census is full (maximum 5 patients at any time)
Where it is running
- Brigham and Women's Hospital — Boston, Massachusetts, United States
- Brigham and Women's Faulkner Hospital — Boston, Massachusetts, United States
Full record on ClinicalTrials.gov
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