A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients

Abstract

Objective: To test the cost effectiveness of Hospital in the Home compared to hospital admission for acute medical conditions. Method: Randomised controlled trial at the Prince of Wales Hospital, Sydney, from October 1995 to February, 1997; 100 patients with acute medical conditions admitted through the Emergency Department. Results: The Hospital in the Home (HITH) group costs per separation ($1,764, CI95% $1,416 - $2,111, n=50) were significantly lower (p < 0.0001, Mann-Whitney U - Wilcoxon Rank Sum) than the control group hospital separation ($3,614, CI 95% $2,881.37 - $4,347.27, n=47) with no significant difference in clinical outcomes, and comparable or better user satisfaction. Conclusion: Given the favourable clinical outcomes the HITH model produces at a lower cost, the cost-effectiveness of the care mode is high, and the allocative efficiency favourable. Implications: As a care model and critical pathway, HITH offers hospitals real bed day savings that can either be used to rationalise resource usage for a given level of activity, or increase throughput.