RCT of hospital at home versus inpatient care in AECOPD (DECAF 0-1)
Research type
Research Study
Full title
Randomised controlled trial of hospital at home compared to standard inpatient management of patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), triaged for hospital admission and with low mortality risk (DECAF 0-1).
IRAS ID
129253
Contact name
Stephen Bourke
Contact email
Research summary
Chronic Obstructive Pulmonary Disease (COPD) is a common lung disease characterised by progressive breathlessness, cough and phlegm. Acute exacerbations (AECOPD) are episodes, often triggered by infection, in which symptoms deteriorate and are the second commonest reason for hospital admission.[1]
Hospital at home (HAH) manages patients in their own home using treatments and support staff from hospital. HAH may foster independence, help maintain usual activities and avoid complications of hospital admission. In AECOPD, NICE agree patient selection for HAH should be based on prognosis, but acknowledge the (previous) lack of a suitable tool. This shortfall has been addressed by the development of the DECAF score, which accurately predicts survival in patients hospitalised with AECOPD.[2] Of importance, approximately 50% of patients currently admitted to hospital have a low risk of death (DECAF 0-1: 1.4%), thus are potentially suitable for HAH. This is more than twice the proportion of patients included in earlier trials. Our model of HAH includes 24/7 clinical and social support. The range of healthcare disciplines and level of support available are greater than many other services, reflecting the selection criteria, but tailored to the patient to ensure use of resource is appropriate.
Before extending HAH to such a wide population, it is important to assess whether this is safe and clinically and cost effective. We propose to conduct an RCT to answer these questions. We will also assess patient and carer preference and, in an embedded qualitative study, interview clinicians, family carers and patients; this will include patients who decline enrolment in the RCT (who consent to be interviewed). The qualitative study and economic evaluation will identify important issues such as patient’s attitudes towards HAH, including concern about care-giver burden, and the true impact on carers, including financial . This will help inform wider implementation of our model of HAH, should it prove to be effective.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
13/NE/0275
Date of REC Opinion
22 Oct 2013
REC opinion
Further Information Favourable Opinion