Variations in diagnostic and therapeutic intensity between home and conventional hospitalization

Objective.To analyse the variations in diagnostic and therapeutic intensity in patients with similar clinical conditions depending on whether they had hospitalization at home (HH) or remained in conventional hospitalization (CH). Design.Observational study of two patient cohorts (HH and CH) selected prospectively. Setting.University Hospital in the Valencia Health Service network, and the Hospital at Home Unit that it administers. Study participants.One hundred and forty-eight consecutive patients admitted to a Hospital at Home Unit, and 148 patients (matched by age, sex, disease group and hospital department) who remained in hospital in spite of fulfilling clinical criteria for HH as assessed by the nurses who normally evaluate suitability of admission to HH. Main outcome measures.Number and cost of diagnostic tests, and cost of drugs and nursing materials per hospitalization in HH and CH. Results.The average number of tests for admission was significantly lower at home than in hospital (HH, 0.89; CH, 3.53); this translated into significant differences in the average diagnostic cost per hospitalization (HH, Pesetas 131; CH, Pesetas 3.316; US$ ≈ 130 Pesetas in 1994). Expenditures on drugs per episode (HH, Pesetas 7028; CH, Pesetas 16 684) was also lower at home, but the differences were not significant for this or for expenditure for nursing materials (HH, Pesetas 3329; CH, Pesetas 2556). Conclusions.Although some limitations of the study do not make it possible to establish unequivocal conclusions, the results point to the existence of different diagnostic and therapeutic patterns in HH and CH, which translate into significant differences in hospitalization costs. Keywords:costs, diagnostic tests, hospitalization at home, variations in medical practice