***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIMS The ' Hospital at home ' ( HaH ) model avoids hospital admission by transferring healthcare and treatment to the patient 's home . We aim ed to compare the effectiveness and direct healthcare costs of treating elderly patients with decompensated heart failure ( HF ) using HaH care vs. inpatient hospital care ( IHC ) in a cardiology unit . METHODS AND RESULTS Eighty patients aged over 65 years who presented at the emergency department with decompensated HF were r and omly assigned to IHC or HaH.  All patients were studied for 1 year . Seventy-one patients completed the study , of these 34 were admitted to cardiology and 37 received HaH care . No significant differences were found in baseline characteristics , including comorbidity , functional status , and health-related quality of life . Clinical outcomes were similar after initial admission and also after the 12 months of follow-up . Death or re-admission due to HF or another cardiovascular event occurred in 19 patients in IHC and 20 in HaH ( P = 0.88 ) . Changes in functional status and health-related quality of life over the follow-up period were not significantly different . The average cost of the initial admission was 4502 + /- 2153 euro in IHC and 2541 + /- 1334 euro in HaH ( P < 0.001 ) . During 12 months of follow-up , the average expenditure was 4619 + /- 7679 euro and 3425 + /- 4948 euro ( P = 0.83 ) respectively . CONCLUSION Hospital at home care allows an important reduction in the costs during the index episode compared with hospital care , whilst maintaining similar outcomes with respect to cardiovascular mortality and morbidity and quality of life at 1 year follow-up OBJECTIVE : To test the cost effectiveness of  Hospital in the Home  compared to hospital admission for acute medical conditions BACKGROUND Hospitalization for acute illness is associated with higher rates of mortality and morbidity , as well as functional decline , for older patients . We have previously shown that treatment in Hospital in the Home ( HITH ) results in less confusion and fewer bowel and bladder problems for these patients . However , it is not clear what impact HITH has on physical and cognitive function . METHODS One hundred patients ( mean age 70 ) presenting to the emergency department and assessed by a senior doctor to require admission were r and omized to be treated in hospital or at home . We measured the Barthel index , Instrumental Activities of Daily Living ( IADL ) index , and Mental Status Question naire ( MSQ ) on admission and at discharge . RESULTS The HITH-treated group improved in the IADL and MSQ indices , whereas the hospital-treated group improved only in the MSQ . The improvement in IADL scores remained significant after adjusting for age , sex , living arrangements , development of confusion , and length of stay . CONCLUSIONS HITH offers a safe option for treatment of older patients with a functional advantage over in-hospital care BACKGROUND Although the hospital is the st and ard venue for short-term medical care , it may be hazardous for older persons . This study was performed to evaluate the feasibility and effectiveness of a physician-led hospital-at-home service for selected elderly patients with acute decompensation of chronic heart failure ( CHF ) . METHODS Prospect i ve , single-blind , r and omized controlled trial with 6-month follow-up for patients 75 years or older admitted to the hospital from April 1 , 2004 , through April 31 , 2005 , for acute decompensation of CHF . Patients were r and omly assigned to the general medical ward  ( n = 53 ) or to the  Geriatric Home Hospitalization Service  (  GHHS ; n = 48 ) . The GHHS provides diagnostic and therapeutic treatments by hospital health care professionals in the home of the patient . RESULTS Patient mortality at 6 months was 15 % in the total sample , without significant differences between the 2 setting s of care . The number of subsequent hospital admissions was not statistically different in the 2 groups , but the mean ( SD ) time to first additional admission was longer for the GHHS patients ( 84.3 [ 22.2 ] days vs 69.8 [ 36.2 ] days , P = .02 ) . Only the GHHS patients experienced improvements in depression , nutritional status , and quality -of-life scores . CONCLUSIONS Substitutive hospital-at-home care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF . This type of care demonstrated clinical feasibility and efficacy in comparison with its alternative . Trial Registration clinical trials.gov Identifier : NCT00623571 BACKGROUND : The “ hospital-at-home ” model may provide adequate care without an adverse effect on clinical outcome , and is generally well received by users . Our objective was to compare hospital-at-home and in-patient hospital care for neuromuscular disease ( NMD ) patients with respiratory tract infections . METHODS : We conducted a prospect i ve r and omized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000 . We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment .  Hospital-at-home was provided as an alternative to in-patient admission . The main outcome measures were need for hospitalization , treatment failure , time to recovery , death during the first 3 months following exacerbation , and cost of patient care . RESULTS : Among 59 consecutive NMD patients eligible for the study , 53 met the criteria for hospital-at-home . Twenty-six subjects were r and omized to home care and 27 to hospital care . No significant differences were found in treatment failure ( 8/26 vs 13/27 , P = .19 ) , time to recovery ( 8.9 ± 4.6 vs 9 ± 8.9 d , P = .21 ) , or mortality at 3 months ( 3/26 vs 4/27 deaths , P = .42 ) between the groups . Hospital-at-home failure was independently correlated with type of NMD ( P = .004 ) with an odds ratio of failure of 17.3 ( 95 % CI 2.1 to infinity ) for subjects with amyotrophic lateral sclerosis .  The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home , compared to the hospitalized individuals . CONCLUSIONS : Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections OBJECTIVES To evaluate hospital readmission rates and mortality at 6-month follow-up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve r and omized , controlled , single-blind trial with 6-month follow-up . SETTING San Giovanni Battista Hospital of Torino . PARTICIPANTS One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were r and omly assigned to a  general medical ward  ( GMW , n=52 ) or to a  geriatric home hospitalization service ( GHHS , n=52 ) . MEASUREMENTS Measurements of baseline sociodemographic information ; clinical data ; functional , cognitive , and nutritional status ; depression ; and quality of life were obtained . RESULTS There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6-month follow-up ( 42 % vs 87 % , P<.001 ) . Cumulative mortality at 6 months was 20.2 % in the total sample , without significant differences between the two study groups . Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW ( 15.5+/-9.5 vs 11.0+/-7.9 days , P=.010 ) . Only GHHS patients experienced improvements in depression and quality -of-life scores . On a cost per patient per day basis , GHHS costs were lower than costs in GMW ( $ 101.4+/-61.3 vs $ 151.7+/-96.4 , P=.002 ) . CONCLUSION Physician-led substitutive hospital-at-home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months , lower healthcare costs , and better quality of life Abstract Objectives : To compare the costs of admission to a  hospital at home scheme  with those of acute hospital admission . Design : Cost minimisation analysis within a pragmatic r and omised controlled trial . Setting :  Hospital at home scheme in Leicester and the city 's three acute hospitals . Participants : 199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period ( median age 84 years ) . Intervention : Hospital at home or hospital inpatient care . Main outcome measures : Costs to NHS , social services , patients , and families during the initial episode of treatment and the three months after admission . Results : Mean ( median ) costs per episode ( including any transfer from hospital at home to hospital ) were similar when analysed by intention to treat — hospital at home £ 2569 ( £ 1655 ) , hospital ward £ 2881 ( £ 2031 ) , bootstrap mean difference −305 ( 95 % confidence interval −1112 to 448 ) . When analysis was restricted to those who accepted their allocated place of care , hospital at home was significantly cheaper — hospital at home £ 2557 ( £ 1710 ) , hospital ward £ 3660 ( £ 2903 ) , bootstrap mean difference −1071 ( −1843 to −246 ) . At three months the cost differences were sustained . Costs with all cases included were hospital at home £ 3671 ( £ 2491 ) , hospital ward £ 3877 ( £ 3405 ) , bootstrap mean difference −210 ( −1025 to 635 ) . When only those accepting allocated care were included the costs were hospital at home £ 3698 ( £ 2493 ) , hospital ward £ 4761 ( £ 3940 ) , bootstrap mean difference −1063 ( −2044 to −163 ) ; P=0.009 . About 25 % of the costs for episodes of hospital at home were incurred through transfer to hospital . Costs per day of care were higher in the hospital at home arm ( mean £ 207 v £ 134 in the hospital arm , excluding refusers , P<0.001 ) . Conclusions : Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital Objective : To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London . Design : R and omized controlled trial . Setting : Patients ' homes in South London . Subjects : Stroke patients not admitted to hospital after a stroke . Intervention : Rehabilitation at home by rehabilitation team for up to three months or usual care . Main outcome measures : The primary outcome measure was the Barthel score . Secondary measures included the Motricity Index , Rivermead ADL , Hospital Anxiety and Depression score and Nottingham Health Profile . Results : Forty-three patients who remained at home were r and omized to rehabilitation team ( 23 ) or ‘ usual ’ care ( 20 ) . The mean number of physiotherapy sessions was three ( range 1–14 ) for the rehabilitation team group and two for the usual care group . Patients ( with a deficit ) in the rehabilitation arm of the trial were more likely to receive  occupational , physical and speech therapy  than those in the control arm ( p = 0.03 , 0.01 and 0.008 , respectively ) . For those patients actually receiving therapy , there was no evidence that the amount received differed between the groups . However , the number of patients in each of these comparisons was very small . The outcome for patients in the  rehabilitation team arm of the trial was nonsignificantly higher ( 0.05 < p < 0.2 ) than for those in the control arm for the areas of Nottingham Health Profile , anxiety , depression , caregiver strain and the proportion of patients living at home . Based on the data observed here , a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33 % difference between intervention and control groups in these outcomes . Conclusion : Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinical ly effective would require trials of adequate size Background and Purpose — Although stroke units reduce mortality and institutionalization , their comparative cost-effectiveness is unknown . Methods — Healthcare , social services , and informal care costs were compared for 447 acute stroke patients r and omly assigned to stroke unit , stroke team , or domiciliary stroke care . Prospect i ve and retrospective methods were used to identify re source use over 12 months after stroke onset . Cost-effectiveness and cost-utility analyses were undertaken . Results — Mean healthcare and social care costs over 12 months were £ 11 450 for stroke unit , £ 9527 for stroke team , and £ 6840 for domiciliary care . More than half the costs were for the initial episode of care . Institutionalization was a large proportion of follow-up costs . Inclusion of informal care increased costs considerably . When informal care was excluded , the incremental cost-effectiveness ratio per percentage point in deaths or institutionalizations avoided in the first year was £ 496 for the stroke unit over domiciliary care ; incremental cost per quality -adjusted life year quality -adjusted life year gained was £ 64 097 between these 2 groups . The stroke team was dominated by domiciliary care . Conclusions — Cost perspectives , especially those related to long-term and informal 
    Output:
    
AUTHORS ' CONCLUSIONS Admission avoidance hospital at home , with the option of transfer to hospital , may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission .