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Comparison of Stress Experienced by Family Members of Patients Treated in Hospital at Home with That of Those Receiving Traditional Acute Hospital Care

Authors

  • Bruce Leff MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Lynda Burton ScD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Scott L. Mader MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Bruce Naughton MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • ,, Jeffrey Burl MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Debbie Koehn MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Rebecca Clark BA,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • William B. Greenough III MD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Susan Guido RN,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Donald Steinwachs PhD,

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • and , John R. Burton MD

    1. From the *Department of Medicine, Division of Geriatric Medicine, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandPortland Veterans Administration Medical Center, Portland, Oregon§Oregon Health and Science University, Portland, OregonState University of New York, Buffalo, New York**Independent Health, Buffalo, New York††Univera Health, Buffalo, New York‡‡Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts
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  • Portions of this work were presented at the annual meetings of the American Geriatrics Society, May 2002, and the Gerontological Society of America, November 2002.

Address correspondence to Bruce Leff, MD, Johns Hopkins University School of Medicine, Johns Hopkins Care Center, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: bleff@jhmi.edu

Abstract

OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.

DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.

SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center.

PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.

INTERVENTION: Treatment in a substitutive HaH model.

MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.

RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean ± standard deviation 1.7 ± 1.8 vs 4.3 ± 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05–0.30).

CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.

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