Current issues of ACP Journal Club are published in Annals of Internal Medicine


Letters

A home-based intervention reduced out-of-hospital deaths and hospitalizations in CHF

ACP J Club. 1999 Nov-Dec;131:A-15. doi:10.7326/ACPJC-1999-131-3-A15



To the Editor

I was dismayed to read the commentary by Farmer (12) on the effectiveness of house calls after hospital discharge. Several excellent randomized controlled trials, similar to the reviewed study, have appeared in major medical journals, and the results of these studies are consistent (2-4). The commentary is dated; the first article cited by Gladman and colleagues (5) predates most randomized controlled trials in this area.

The commentary also appears to be unduly influenced by noncomparable health services research; the second article cited in the commentary by Sheppard and colleagues (6) reports a study of the home-hospital method of care compared with routine hospital care, not simple follow-up visits after discharge. This study, and the commentary in general, seems flavored by the U.K. National Health Service. Studies done within U.S. health care systems have shown that follow-up visits after discharge consistently reduce overall utilization and costs (2-7). Consequently, many mature managed care organizations liberally use physicians and nurse practitioners to visit high-risk patients at home after discharge. For these reasons, the commentary misses the mark, at least for American readers.

Wayne C. McCormick, MD, MPH
Harborview Medical Center
Seattle, Washington


References

1. Farmer A. Commentary on "A home-based intervention reduced out-of-hospital deaths and hospitalizations in CHF." ACP J Club. 1999 Jul-Aug;131:6. Comment on: Stewart S, Vandenbroek AJ, Pearson S, Horowitz JD. Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure. Arch Intern Med. 1999;159:257-61.

2. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613-20.

3. Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. 1995;333:1184-9.

4. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190-5.

5. Gladman JR, Lincoln NB. Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study). Age Ageing. 1994;23:9-13.

6. Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ. 1998;316:1791-6.

7. Stewart S, Vandenbroek AJ, Pearson S, Horowitz JD. Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure. Arch Intern Med. 1999;159:257-61.