Comparison of Stress Experienced by Family Members of Patients Treated in Hospital at Home with That of Those Receiving Traditional Acute Hospital Care Bruce Leff, MD, à w Lynda Burton, ScD, w Scott L. Mader, MD, §z Bruce Naughton, MD, k Ãà ww Jeffrey Burl, MD, zz Debbie Koehn, MD, w Rebecca Clark, BA, w William B. Greenough III, MD, à Susan Guido, RN, à Donald Steinwachs, PhD, w and John R. Burton, MD à w OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care. DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a subs- titutive HaH care model. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community- dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerba- tion of chronic heart failure, exacerbation of chronic ob- structive pulmonary disease, or cellulitis. INTERVENTION: Treatment in a substitutive HaH model. MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a poten- tially stressful situation and, if so, whether stress was as- sociated with the situation while the patient received care. RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean  standard deviation 1.7  1.8 vs 4.3  3.1, Po.001; median 1 vs 4, Po.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio 5 0.12, 95% confidence interval 5 0.05–0.30). CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members. J Am Geriatr Soc 56:117–123, 2008. Key words: ‘‘Hospital at Home’’; caregiver; stress; aged; hospital care; acute care for the elderly P roviding acute hospital-level care at home, in a Hospital at Home (HaH), as a substitute for traditional acute hospital admission, 1 has been demonstrated in a U.S. model to be feasible, efficacious, 2 and associated with greater pa- tient and family member satisfaction with care. 3 Although some believe that patients ‘‘mend better at home,’’ 4 others, including ethicists, policymakers, and oth- er potential stakeholders in dissemination of HaH into widespread practice, may be concerned that providing acute hospital-level care in the home will shift the burden of care provision from hospital staff to family members and cause them significant stress or burden. 5 Although examined in the context of providing care to chronically ill frail elderly people in a number of care settings, 5–15 there are few published data on stress experi- enced by family members of patients during an episode of acute hospitalization. The burden imposed by HaH on caregivers has been examined, although these studies chiefly examined early-discharge models of HaH outside the United States 16–18 and used a measure 19 focused on stress experienced by caregivers after discharge from acute care rather than stress associated with an episode of acute illness. The aim of this study was to describe and compare self- reported stress experienced by family members of acutely ill older patients cared for in a substitutive HaH with that experienced in the traditional acute hospital. It was Portions of this work were presented at the annual meetings of the American Geriatrics Society, May 2002, and the Gerontological Society of America, November 2002. Address correspondence to Bruce Leff, MD, Johns Hopkins University School of Medicine, Johns Hopkins Care Center, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: bleff@jhmi.edu DOI: 10.1111/j.1532-5415.2007.01459.x From the à Department of Medicine, Division of Geriatric Medicine, School of Medicine, and w Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; z Portland Veterans Administration Medical Center, Portland, Oregon; § Oregon Health and Science University, Portland, Oregon; k State University of New York, Buffalo, New York; Ãà Independent Health, Buffalo, New York; ww Univera Health, Buffalo, New York; and zz Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts. JAGS 56:117–123, 2008 r 2007, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00