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Terri R. Fried, MD; Carol van Doorn, PhD; John R. O'Leary, MA; Mary E. Tinetti, MD; Margaret A. Drickamer, MD

Arch Intern Med. 2000;160:1501-1506.

Background  Although the home is expanding as a potential site for acute illness treatment, little is known about patients' preferences for home vs the hospital.

Objective  To determine older persons' preferences for home or hospital as a treatment site for acute illness and factors associated with preference.

Methods  Two hundred forty-six community-dwelling persons aged 65 years or older hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia were identified in 2 urban teaching hospitals and received telephone interviews 2 months after hospitalization. They were asked their preference for home or hospital treatment, given the availability of equivalent therapies and outcomes at the 2 sites and a nursing visit and several hours of home health aide assistance daily in the home. They were also asked about changes in preference with changes in the description of the outcome or the availability of services.

Results  If home and hospital offered equivalent outcomes, 46% of the sample preferred treatment at home. Preferences were heavily dependent on the outcome of the illness, physician opinion about the best site of care, and the provision of house calls. Higher education, white race, living with a spouse, being deeply religious, and having 2 or more dependencies in activities of daily living were associated with a preference for home treatment.

Conclusions  Under conditions of equivalent outcome, preferences for treatment site are almost equally divided between home and hospital. Explicit elucidation of preferences is necessary if patients' preferences are to play a meaningful role in decision making about site of care.

From the Veterans Affairs Connecticut Healthcare System, West Haven, Conn (Drs Fried and Drickamer), and Yale University School of Medicine, New Haven, Conn (Drs Fried, van Doorn, Tinetti, and Drickamer and Mr O'Leary).

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