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Hospital at home versus hospital treatment of COPD exacerbations

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Review of: Echevarria C, Gray J, Hartley T, et al. Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial. Thorax 2018;79:713–22.

Key learning points

  • Although hospital at home (HAH) is recommended for some people with a chronic obstructive pulmonary disease exacerbation, there are no evidence-based patient-selection criteria.

  • This non-inferiority randomised controlled trial compared the cost of HAH and usual care in patients at low risk of in-hospital mortality.

  • The mean cost of treatment over 90 days was £1016 lower with HAH than with usual care.

In patients with an exacerbation of chronic obstructive pulmonary disease (COPD) who have been assessed as at low risk of in-hospital mortality, the cost of hospital at home (HAH) treatment was lower than the cost of usual care and preferred by most patients.1


The DECAF (Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation) score (range 0–6) is a predictive tool that can be used …

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  • Contributors DTB Team.

  • Provenance and peer review Commissioned; Internally peer reviewed.