Hospital stays are long and the risk of readmission is 40-60%. Systematic reviews have concluded that hospital at home contribute to better health outcomes for patients and lower costs.
About the project
The overall goal of the project is to develop knowledge that contribute to improved health- and care services for COPD patients and their relatives.
In two externally funded PhD projects, we have studied predictors of prolonged hospital stay, whether there is a difference in readmission rate to hospital depending on which department COPD patients are admitted to (pulmonary department versus general internal medicine departments), how patients experience being treated at home for their COPD exacerbation, how spouses manage to combine the role as informal caregiver with the role as spouse, and their interaction with the healthcare system when hospital treatment is carried out at home.
Method
The project combined different methods. We interviewed patients, relatives, and nurses, we carried out a survey, and exploited data from electronic patient records, and self-collected clinical data.
The qualitative data were analyzed using thematic analyses, while the quantitative data were reported as descriptive statistics and analyzed using regression analyses.
In the analyses on readmission rates, we used propensity score methods to identify comparable patients.
Results
The results showed that comorbidity, severe COPD exacerbation, poor nutritional status reflected by low serum albumin levels, and admission to hospital at the end of the week (Thursday-Saturday) were associated with increased risk of prolonged hospital stays (more than 11 days).
Furthermore, we found that the readmission rate 12 months after discharge was similar for patients treated in the pulmonary department and patients treated in general internal medicine departments.
COPD patients treated at home for acute exacerbation perceived the treatment program as safe, informative, and helpful in managing the disease in daily life.
The spouses of patients treated at home found it challenging to combine the role of informal caregiver and spouse. They made extensive efforts to maintain normality and continuity in daily life.
The results also showed that spouses negotiated with the sick person about whether and when to seek help for exacerbation of the disease. The spouses felt responsible for managing severe exacerbation of the disease in the sick person while being reluctant to seek help from the healthcare system, despite describing a great need for professional help, support, and relief.
The results from the survey of relatives of COPD patients (n=823) showed that they provided much practical assistance and help to the patients. However, what they found most challenging was the continuous concern for the patient's health condition.
Results from the analysis of interviews with ambulatory nurses showed that the presence of relatives during home visits gave new possibilities in nurses' conversations with patients and relatives, but also made the interaction and collaboration during home visits more complex.
Theses from the project
Cand.med. Ying Wang defended her thesis "Acute exacerbation of COPD: length of hospital stay, readmission rates and patients' experience of a hospital at home program. A combined quantitative and qualitative approach" on Dec. 5, 2013.
MA Gunvor Aasbø defended her thesis "Affected and responsible: A qualitative study of family caregivers in interaction with chronically ill persons and health care professionals" on May 26, 2017.
Financing
The South-Eastern Norway Regional Health Authority and The Research Council of Norway