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Early discharge hospital at home
Sasha Shepperd1, Helen Doll, Joanna Broad
1Department of Public Health, University of Oxford, Rosemary Rue Building, Headington, Oxford, Oxfordshire, UK, OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk
The Cochrane Database of Systematic Reviews
|January 23, 2009
Summary
Hospital at home services offer active treatment in the patient's home. This systematic review found insufficient evidence of economic benefit or improved health outcomes for hospital at home compared to inpatient care.
Area of Science:
- Health Services Research
- Geriatric Medicine
- Rehabilitation Medicine
Background:
- 'Early discharge hospital at home' provides acute care in the patient’s residence.
- This service aims to manage conditions that would otherwise require inpatient hospital stays.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness and cost of hospital at home services versus traditional inpatient care.
- To evaluate patient outcomes, including mortality, readmission, and residential care placement.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases including Cochrane EPOC, MEDLINE, EMBASE, CINAHL, and EconLit.
- Individual patient data (IPD) meta-analysis used Cox regression and fixed-effect inverse variance methods.
Main Results:
- No significant difference in mortality for stroke patients or mixed elderly conditions.
- Increased readmission rates observed for elderly patients in hospital at home.
- Reduced placement in residential care for stroke and elderly patients.
- Patients reported higher satisfaction with hospital at home services.
- Mixed evidence on cost savings and insufficient data on readmission for surgical patients.
Conclusions:
- Current evidence does not objectively support the economic benefits or improved health outcomes of hospital at home services.
- Further research is needed to clarify the cost-effectiveness and clinical efficacy of these services.
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