AIM: Home x-ray feasible, beneficial for elderly patients
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Hospitalization represents risks for frail, elderly patients including delirium, falls and infection. However, advances in technology and communications have made possible increasing delivery of healthcare services in the homes.
To determine the feasibility of home-delivered portable chest exams, a group of researchers devised a randomized controlled trial of patients in the Home Health Service of San Giovanni Battista Hospital of Torino, Italy.
The researchers assigned 34 patients to home exams and 35 to hospital exams between June 2008 and June 2009. Mean patient age was 78 years and 45 percent were male.
Outcomes included the feasibility and quality of radiological imaging at home, incidence of delirium after the exam and patient satisfaction, explained Nicoletta Aimonino Ricauda, MD, of San Giovanni, and colleagues.
The primary indications for x-ray in both groups were suspected exacerbation of congestive heart failure, exacerbation of chronic obstructive pulmonary disease or pneumonia. Exams confirmed the clinical suspicion in approximately 70 percent of the cases, according to the researchers.
In the hospital cohort, 17 percent of patients required treatment for an acute confusional state. No patient in the home group developed delirium; and 94 percent of home patients reported very good or excellent satisfaction with the process. Finally, seven radiologists blinded to the origin of the exam assessed image quality and found home and hospital studies to be of comparable quality.
Ricauda and colleagues acknowledged that the small sample size and experienced hospital-at-home unit may have limited the generalizability of the findings, but nevertheless concluded that the pilot trial indicated “healthcare is going home.”