Hospital at home for COPD patients - an integrated care program at Akershus University Hospital

A general goal at present is better care for the chronically ill. Akershus University Hospital (Ahus) will try to realize this goal in the case of patients with chronic obstructive pulmonary disease (COPD), by implementing an integrated care program that includes early discharge from hospital in collaboration with local health authorities responsible for primary care. Models with early discharge, also named 'hospital at home', have been tried out in the United Kingdom and elsewhere with some success, and have been used as examples where patients experience seamless care, with spread of competence and improved cross-institutional collaboration as secondary benefits. British and other studies suggest that hospital at home is not inferior to in-hospital trea tment as regards medical outcomes. Previous studies have not included detailed cost-utility analyses. We intend to study whether international experiences are applicable to Norway, and will provide an analysis that includes cost-utility analyses at hospit al, regional, national, and local community levels. The method is a randomised controlled trial of hospital at home versus traditional in-hospital treatment for COPD patients 40-85 years admitted to Ahus for respiratory distress. Patients will be assess ed for eligibility and asked for informed consent within 16 hours. Those randomised to hospital at home will leave hospital within 24 hours from admission. The first three days at home they will be visited by specialised nurses from the department of lung diseases, and they will have the possibility to contact the project team by mobile phone at any time. Data will be collected by questionnaires to patients, relatives, and involved personell, as well as from the hospital electronic patient record. Clinic al data are collected at admission, first three days, and follow-up. We plan to use this study as a model for studies of integrated care programs for patients with other types of chronic diseases.