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document
Prolonged effects of a home-based intervention in patients with chronic illness . BACKGROUND Data on the long-term benefits of nonspecific disease management programs are limited . We performed a long-term follow-up of a previously published randomized trial . METHODS We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary , home-based intervention ( HBI ) ( n = 260 ) or to usual postdischarge care ( n = 268 ) . RESULTS During follow-up , HBI had no impact on all-cause mortality ( relative risk , 1.04 ; 95 % confidence interval , 0.80-1.35 ) or event-free survival from death or unplanned hospitalization ( relative risk , 1.03 ; 95 % confidence interval , 0.86-1.24 ) . Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization , with 677 readmissions vs 824 for the usual care group ( mean +/- SD rate , 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions/patient per year ; P = .08 ) . When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years , post hoc analyses showed that HBI reduced readmissions by 14 % within 2 years in patients without this condition ( mean +/- SD rate , 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission/patient per year ; P = .04 ) and by 21 % in all surviving patients within 3 to 8 years ( mean +/- SD rate , 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions/patient per year ; P = .03 ) . Overall , recurrent hospital costs were significantly lower ( 14 % ) in the HBI group ( mean +/- SD , 823 dollars +/- 1642 dollars vs 960 dollars +/- 1376 dollars per patient per year ; P = .045 ) . CONCLUSION This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses , except for chronic obstructive pulmonary disease .
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Intervention_Other
home-based intervention
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Intervention_Physical
multidisciplinary ,
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Intervention_Other
home-based intervention ( HBI )
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Intervention_Other
usual postdischarge care
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Intervention_Other
HBI
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Intervention_Other
HBI
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Intervention_Other
HBI
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Intervention_Other
HBI
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Intervention_Other
HBI
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Outcome_Mortality
all-cause mortality
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Outcome_Physical
recurrent hospitalization
25772
Outcome_Mortality
all-cause mortality
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Outcome_Mortality
event-free survival from death
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Outcome_Physical
unplanned hospitalization
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Outcome_Physical
unplanned hospitalization
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Outcome_Other
hospital activity
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Outcome_Other
readmissions
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Outcome_Other
recurrent hospital costs
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Participant_Condition
chronic illness
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Participant_Condition
chronic illness
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Participant_Sample-size
260
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Participant_Sample-size
268
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Participant_Condition
chronic obstructive pulmonary disease