Patients who receive home-care services need, on average, about half as many days of care as those who remain in hospital with the same condition, a new British study indicates.

Further, the home-care patients are less likely to be readmitted to hospital, and their health status does not differ from their hospital counterparts despite the markedly shorter treatment period, researchers at the University of Leicester report.

Patients in the "hospital at home" program (the British term for home care) required eight days of treatment, compared with 14.5 days for those treated in hospital.

Three months after the initial treatment, home-care patients had an average of nine days total care, compared with 16 days for the hospital group.

"Hospital at home resulted in significantly shorter lengths of stay, which did not lead to a higher rate of subsequent admission," Dr. Andrew Wilson, a professor of epidemiology and community health, reported in the latest edition of the British Medical Journal. "The hospital at home scheme delivered care as effectively as hospital, with no clinically important differences in health status."

Researchers postulated that the treatment period for home-care patients was shorter because rehabilitation was "more aggressive" in the home and because there was no disruption in regular home care. (Most patients, because they were frail and elderly, had some form of home support, but some of the hospital patients lost their regular care-provider and had to adjust to a new one.)

The study is important because it is one of the first randomized clinical trials that compares the outcome of home and hospital care. All 199 patients studied had acute illnesses, principally cardiovascular and respiratory problems. Their median age was 84. Half were assigned to each type of care.

In a companion paper, the researchers also examined costs, and, not unexpectedly, home care was substantially cheaper.

In the initial treatment phase, costs were 30 per cent lower, an average of $6,135 for home care versus $8,785 for hospital care.

The savings were maintained after three months, even when subsequent hospital visits were included in the costs of the home-care group. The average cost was $11,425 for hospital care, compared with $8,875 for three months of post-acute home care.

"Hospital at home is justified on clinical and economic grounds," Dr. Wilson wrote.

In Leicester, a day in hospital cost about $500, and a day of home care -- including nursing care for up to 24 hours -- cost $325.

Last month, Victoria health economist Marcus Hollander published one of the first detailed studies comparing the costs of home care and institutional care in Canada.

That research concluded that home care costs, on average, $8,000 a year less, regardless of the severity of the patient's condition.

Dr. Hollander's research, however, focused on elderly people with chronic illness, not on post-acute patients.

According to Statistics Canada, 523,000 adults, 2.4 per cent of the population, received home care in 1994-95, the most recent year for which statistics are available. The majority of users, 64 per cent, were seniors.

Nationally, governments spend $2.1-billion annually on home care, about 4 per cent of public-health spending. By comparison, they spend $7-billion a year on long-term care facilities and $26-billion on acute-care hospitals.

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