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Early discharge hospital at home
Daniela C Gonçalves-Bradley1, Steve Iliffe, Helen A Doll
1Nuffield Department of Population Health, University of Oxford, Oxford, UK.
The Cochrane Database of Systematic Reviews
|June 27, 2017
Summary
Hospital at home services offer active treatment in patients' homes, but this review found insufficient evidence of economic benefits or improved health outcomes compared to inpatient care.
Area of Science:
- Health Services Research
- Gerontology
- Rehabilitation Medicine
Background:
- Early discharge hospital at home provides acute care in a patient's residence.
- This service is an update of a Cochrane review comparing home-based care with inpatient hospital treatment.
Purpose of the Study:
- To evaluate the effectiveness and cost of hospital at home services versus traditional inpatient hospital care.
- To determine if home-based acute care offers advantages in patient outcomes and economic impact.
Main Methods:
- Systematic review and meta-analysis of 32 randomized trials involving 4746 adult patients.
- Searched multiple databases including Cochrane CENTRAL, MEDLINE, Embase, CINAHL, and EconLit up to January 2017.
- Assessed the certainty of evidence using the GRADE approach for key outcomes.
Main Results:
- Hospital at home likely results in little to no difference in mortality for stroke patients and those with mixed conditions.
- It may reduce institutionalization and slightly improve patient satisfaction across various conditions.
- A probable reduction in hospital length of stay was observed, particularly for stroke patients (approx. 7 days shorter).
- Evidence on cost-effectiveness remains uncertain across all studied patient groups.
Conclusions:
- Current evidence is insufficient to support the economic benefits or improved health outcomes of hospital at home services.
- While potentially reducing length of stay and institutionalization, significant uncertainties remain regarding overall effectiveness and cost.
- Further research is needed to clarify the role and economic viability of hospital at home care.
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