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[Hospital-at-home as a solution for the treatment requirements of acute exacerbation in multiple sclerosis]
D Steinmetz1, H Edelstein, S Dishon
1Hospital-at-Home Department, Continuing Care Unit, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel.
Insights
Hospital-at-Home (H.H) treatment with intravenous methylprednisolone for Multiple Sclerosis (M.S.) exacerbations is safe, cost-effective, and preferred by patients and families over hospitalization. This approach significantly reduces costs and enhances patient satisfaction.
Area of Science:
- Neurology
- Health Services Research
Context:
- Multiple Sclerosis (M.S.) exacerbations require treatment with intravenous methylprednisolone.
- Traditional treatment involves hospitalization in neurological departments.
- Hospital-at-Home (H.H.) offers an alternative care delivery model.
Purpose:
- To assess the satisfaction, safety, and cost-effectiveness of H.H. intravenous methylprednisolone for M.S. exacerbations.
- To compare H.H. treatment with traditional inpatient care.
- To evaluate patient and family experiences with H.H. versus hospitalization.
Summary:
- A joint initiative between a Multiple Sclerosis center and a Hospital-at-Home department provided 30 courses of intravenous methylprednisolone to 26 M.S. patients at home.
- The study analyzed 30 treatment courses for 26 M.S. patients receiving home-based intravenous methylprednisolone.
- H.H. treatment costs were 14% of inpatient costs, representing an 86% cost saving.
Impact:
- H.H. treatment demonstrated exceptional safety, with no adverse events necessitating hospital readmission.
- Patient and family satisfaction was significantly higher with H.H. treatment compared to hospitalization.
- Intravenous methylprednisolone administration via H.H. is a safe, cost-effective, and preferred option for M.S. exacerbations.
Abstract:
Cooperation between the Multiple Sclerosis center at the Carmel medical center and the Hospital-at-Home (H.H) department of the continuing care unit in the Haifa and Western Galilee district of the Clalit Health Services has made it possible to give methylprednisolone intravenously to Multiple Sclerosis (M.S) patients during an acute exacerbation of the disease, in their home. In this study, we describe the joint work of the two centers. We have summarized 30 treatment courses given to 26 patients in their homes, following referral by the M.S. center, in the year 1999. The aims of the study included assessing satisfaction, safety and cost-effectiveness in a treatment course in the HH framework, as compared to the same treatment being conducted in the framework of hospitalization in various neurological departments, as was done in the past in the same group of patients. The expenses involved in HH for this group of patients were only 14% of the parallel treatment in the hospital (a savings of 86%). The treatment has proven to be extremely safe. There were no side-effects that required returning patients to the hospital, and the treatment was given in conditions of maximum comfort for the patient and his family. A telephone survey was conducted, which compared the satisfaction with the HH treatment, and the burden caused the patient's family to prior hospitalization for the same treatment. For all of the parameters examined, greater satisfaction was distinctly proven in the HH treatment. In light of these findings, we can conclude that giving methylprednisolone intravenously to M.S patients during an acute exacerbation, in the HH framework, is a safe and cost effective treatment, preferred by the patient and his family.