A meta‐analysis of “hospital in the home”

Abstract

Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs. Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012. Study selection: Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years. Data extraction: Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist. Data synthesis: 61 RCTs met the inclusion criteria. HITH care led to reduced mortality (odds ratio [OR], 0.81; 95% CI, 0.69 to 0.95; P = 0.008; 42 RCTs with 6992 patients), readmission rates (OR, 0.75; 95% CI, 0.59 to 0.95; P = 0.02; 41 RCTs with 5372 patients) and cost (mean difference, − 1567.11; 95% CI, − 2069.53 to − 1064.69; P < 0.001; 11 RCTs with 1215 patients). The number needed to treat at home to prevent one death was 50. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies; carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00; 95% CI, − 0.19 to 0.19). Conclusion: HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden.

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’

“…Although discharge from hospital is a crude measure, the reduction in subsequent readmissions seen in this study may be related to efforts to link emergency care of older people to on-going care in community settings (so-called ‘vertical integration’ [19]), and is consistent with the research literature on hospital at home, which offers significant advantages in terms of lower mortality [7] and reduced functional decline [8]. …”

Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio en España

“…En la figura 2 (20), se especifican los costes de determinados procesos infecciosos en 3 unidades HAD con programa de TADE (Tratamiento Antimicrobiano Domiciliario Endovenoso) consolidado. Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio En un meta-análisis publicado en el año 2012 los autores observaron una fuerte evidencia de reducción de costes por episodio (diferencia media, − 1567,11$; IC 95%, − 2069,53 a -1064,69; p < 0,001) a pesar de la gran heterogenicidad (χ 2 = 237.45; p < 0.001; I 2 = 96%) (18). Se objetivaron ahorro de costes en todos los subgrupos de análisis.…”

Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment

“…It is of note, however, that recent reports [23456] seem to overcome those limitations by demonstrating maturity and health value generation of Home Hospitalization/Early Discharge. Likewise, the 2016 Cochrane review [7] concludes that Home Hospitalization may constitute an effective alternative to inpatient care for a selected group of elderly patients requiring hospital admission.…”