New Trend: Hospital Care At Home? Study Finds Home X-Rays Beneficial for Elderly

Mobile Health ClinicAt a time of widely reported rising risks from widespread hospital errors and hospital-acquired infections, doctors in Italy have conducted a pilot study that showed that at least some hospital care (routine X-rays) can better be delivered to elderly patients at home.

In a new study recently published in The Archives of Internal Medicine, a journal of the American Medical Association, doctors in Torino, Italy found that use of mobile Radiology Units to provide required X-Rays to elderly patients at home, rather than in the hospital, was highly successful. Doing so produced X-Rays of quality equal to those taken in the hospital, avoided exposing the patients to hospital-induced delirium or infections, which are common results of hospitalization, and was preferred by the patients.

The new study, The RAD-HOME Project: A Pilot Study of Home Delivery of Radiology Services, was published in the August 8, 2011 issue of The Archives of Internal Medicine, a journal of the American Medical Association.

In concluding their study report, lead author Vittoria Tibaldi, MD of the Department of Medical and Surgical Disciplines–Geriatric Section, San Giovanni Battista Hospital in Torino, Italy and colleagues explained the success of their pilot study, called for further study of similar health care delivery to the elderly at home, and then commented: “this pilot trial suggests that “health care is going home.”

This focus on avoiding hospitalization where possible for elderly and vulnerable patients seems particularly timely. Recent reports by the World Health Organization and others have highlighted the rising risks of hospital-acquired infections and medical errors.

In fact, in connection with a report released in July, 2011 by the World Health Organization (WHO), its patient safety envoy famously observed that one’s chances of dying from a hospital error or hospital-acquired infection (1 in 300) are far greater than one’s chances of dying in an airplane crash (1 in 10 Million).

The Study – Methodology

Out of 463 patients receiving home health care through the Hospital at Home Service (HHS) of San Giovanni Battista Hospital in Torino, Italy, between June 2008 and June 2009, Dr. Tibaldi and colleagues identified 69 elderly patients (average age 78) who were “immobilized or chair bound, acutely ill, at intermediate or high risk of delirium … and in need of a radiological examination of the chest, pelvis, hips, joints, upper or lower limbs, hands, or feet.”

They randomly assigned 34 of these patients to receive their X-Rays at home via a mobile radiology unit of the Hospital, and 35 of the patients to receive their X-Rays in the Hospital.

As explained by the researchers, “Radiological examinations at home were performed by qualified radiology technicians using a light-weight, portable, high-frequency x-ray tube, improved cassettes (with imaging plate inside), and a mobile radiological station (Computed Radiography POC 260; Carestream Health, Rochester, New York) with remote visualization and real-time processing of acquired images.”

“The equipment, transported in a small van, was in conformity with all applicable laws and the radiation safety standards of the relevant national and international organizations,” the authors wrote. “The operators position themselves and the equipment to prevent anyone, except the patient, from entering the controlled area during x-ray exposure. If it is necessary to stand within the controlled area, the operators wear protective clothing,” they reported.

“Using the Picture Archive and Communication System, the radiology technicians directly transmitted the images acquired at home via wireless broadband Internet to the radiologists in the hospital who read radiographs in real time,” the researchers explained.

Most of the X-Rays, both those given via the mobile unit at home and those given in the hospital, were “performed for suspected exacerbation of congestive heart failure, exacerbation of chronic obstructive pulmonary disease, or pneumonia, and there were no differences in indication for radiography between the home and hospital radiography groups,” the authors stated.

The researchers compared the quality and clinical outcomes of the mobile in-home X-Rays with those taken in the hospital to determine “feasibility and quality of radiological imaging at home, the incidence of delirium after the x-ray examination, and patient satisfaction.”

Findings

The scientists found the quality of the X-Rays delivered at home equally as good as those given in the hospital. “There were no significant differences in the quality of chest radiographies performed at home and those performed in hospital,” they wrote.

The clinical outcomes of the X-rays performed in the two study groups were also comparable. “In both groups, radiographs confirmed the clinical suspicion in approximately 70% of cases,” the authors stated.

However, some of the elderly patients who had the X-rays in the hospital suffered from delirium as a result of the experience, while none of those who received the X-rays at home did, and the patients were generally more satisfied with the home X-rays.

The authors explained:

“After radiological examination, an acute confusional state requiring treatment occurred in 17% of patients in the hospital radiography group, whereas no patient in the home radiography group developed delirium. The onset of delirium (100 % of patients were hyperactive) occurred within few hours of hospital radiological examination, and the mean (SD) duration of the episode was1.2 (4.2) days. The mean (SD) score of the Delirium Rating Scale was 0.79 (3.6). Satisfaction with home radiography was very good or excellent for 94% of patients.”

Conclusions & Implications

The authors concluded:

“Among frail elderly patients, radiographs performed at home were of similar quality to those performed after admission to the hospital, and resulted in a significantly lower incidence of delirium. Almost all patients were highly satisfied undergoing imaging studies at home. Modern portable x-ray units are light enough to be easily transported and used in the home and may spare frail patients the trauma of transportation and unfamiliar surroundings, as well as other hospital-associated adverse effects.

Our sample size was small and the findings may not be generalizable, given that the study was conducted at only 1 center and by an operationally mature hospital-at-home unit. Nevertheless, this pilot trial suggests that “health care is going home.”

The results and focus of this study seem encouraging, in light of the widely reported growing concern with widespread risks of hospital errors and hospital-acquired infections. The authors of this study have highlighted a promising and practical approach that can be useful to seniors and their family caregivers.

If a routine X-ray has been prescribed for an elderly or vulnerable patient, it may be wise to ask your doctor about possible availability of safe and reputable mobile X-ray units in your area that could deliver these services at home.

More Information

The full study report is available in the August 8, 2011 issue of The Archives of Internal Medicine, a journal of the American Medical Association.

For information on the growing field of Mobile Health Services, see E.g. the website of the Mobile Health Clinics Network, a non-profit organization dedicated to “advocating Mobile Healthcare as a key solution for advancing access to healthcare on a continuing basis and in times of national emergency disaster.” The Mobile Health Clinics Network is sponsoring a Mobile Health Clinics Forum on October 1-4, 2011 in Palm Springs, California.

For more on the dangers of hospital infections, see

The gruesome math of hospital infections,” April 14, 2011 by CNN;

Deadly infections: How good is your hospital at preventing them?” June, 2011 by Consumer Reports Health.org;

See also “Your hospital survival guide: The basics,” June 2011, by Consumer Reports Health.org.

And, see the HelpingYouCare™ reports on:

Alarming Trend: Medical Errors Have Increased in the U.S.

New Patient Safety Program Launched under Affordable Care Act

Private Hospital ICU Rooms Found to Reduce Infection Rate Significantly

And, see the HelpingYouCare™ resource pages on:

Information About Home Health Care

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Copyright © 2011 Care-Help LLC, publisher of HelpingYouCare™.

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