The HOME Study
Research type
Research Study
Full title
The HOME Study: A study comparing two different ways of looking after older people in hospitals to see if we can improve how quickly they go home.
IRAS ID
205376
Contact name
Heather House
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
2 years, 5 months, 31 days
Research summary
Research Summary
NHS general hospitals have more than two million unplanned admissions of people aged 65 and older every year. These patients typically spend more time in hospital than those aged under 65. Long hospital stays are bad for older patients: they can get new illnesses like infections and lose their independence. They are also bad for the NHS which has a shortage of hospital beds. Psychological problems, like dementia, confusion, depression and anxiety, are common in older patients and these are an important cause of long hospital stays. These problems are often not identified in busy hospital wards where the focus is on patients’ physical illnesses.
In this study, we will research whether adding a new approach (sometimes called Proactive Liaison Psychiatry) to the identification and management of psychological problems reduces the time that older people spend in acute general hospital wards.
We will recruit approximately 3,244 patients aged 65 and older, who have been admitted to acute wards in hospitals in Oxfordshire, Glasgow, Cambridgeshire and Devon. They will be randomly allocated to receive usual care, or usual care plus the new approach (which will involve seeing a doctor or nurse who specialises in psychological problems in the medically ill). We will study whether the new approach reduces the time that patients spend in hospital and whether it improves their quality of life and independence. We will also interview patients, carers and healthcare professionals to learn about their experiences of the new approach.
The study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme.
Summary of Results
The HOME Study is the first randomised controlled trial to test the effectiveness and cost-effectiveness of proactive integrated consultation-liaison psychiatry (PICLP) compared with usual care. The study took place in 24 medical wards of three UK NHS hospitals. 2,744 older patients, who had been admitted to hospital in an emergency, took part.
The study findings indicate that PICLP can be delivered at scale, is seen by older inpatients and ward staff as both acceptable and as enhancing medical care, and may be cost-saving for the medical service in the short-term.
The findings do not provide sufficient evidence to recommend implementing PICLP in order to reduce the time older patients spend in hospital. However, the findings do suggest a number of ways in which it could be made more effective. These include more intensive delivery, a greater focus on patients at high risk of very long stays (more than 2 weeks), and a greater ability to influence the aspects of both inpatient and out-of-hospital care that delay discharge.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
17/SC/0497
Date of REC Opinion
6 Oct 2017
REC opinion
Favourable Opinion