[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]

To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen.

Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home.

A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001).

Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD.