Discussion
This is the first time, to our knowledge, that the efficacy
of a hospital-at-home model for managing NMD patients
with respiratory tract infection has been prospectively evaluated
in a controlled study. Our major conclusion is that
for such patients home hospitalization is as effective as
conventional hospital care, according to the observation
that the proportion of individuals who had a complicated
clinical course leading to intubation and/or tracheostomy
was similar to that of the hospitalized group, and that both
time to recovery and mortality at 3-month follow-up did
not significantly differ in the 2 groups. Although the failure
rate of approximately 30% for our home-based model
seems high, it is in line with previous studies in the hospital
setting, which reported treatment failure in the range
20–50% of subjects, and concluded that respiratory tract
infections are a major cause of morbidity and mortality for
this population.