Early discharge hospital at home

Gonçalves‐Bradley, Daniela C; Iliffe, Steve; Doll, Helen; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

doi:10.1002/14651858.cd000356.pub4

Cited by 156 publications

(254 citation statements)

References 107 publications

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“…The updated Cochrane review undertaken in 2017 of 32 RCTs of HITH showed that, compared to hospital care, HITH provided improvement in mortality at 3‐6 months in COPD patients (RR = 0.53, P = .096) and stroke patients (RR = 0.92, P = .73) and no improvement in older people with a mix of medical conditions (RR = 1.07, P = .71) in early discharge hospital at home patients . Readmission was reduced in COPD patients (RR = 0.86, P = .29) and no differences in stroke patients (RR = 1.09, P = .7) or older patients with a mix of medical conditions (RR = 1.25, P = .069) were observed …”

Section: Discussionmentioning

confidence: 99%

“…The Cochrane review summary of findings showed that for patients with mixed conditions readmission rate was 19.1% (95% CI 14.6%‐24.7%) and mortality rate was 10% (95% CI 7.1%‐13.9%) . Readmission rates from the observational studies ranged from 0% to 15% except in children and more than 90% of the studies reported a mortality rate of less than 2.5%.…”

Section: Discussionmentioning

confidence: 99%

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Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

et al. 2018

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“…A reduced length of stay in hospitals may leave less time for recovery from acute illness, as well as less time to assess the patients further needs and develop an adequate discharge plan . The financial effect of early discharge on health service costs is still uncertain .…”

Section: Introductionmentioning

confidence: 99%

Discharge from hospital – a national survey of transition to out‐patient care

Åhsberg

2018

Scandinavian Caring Sciences

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Introduction Despite a generally decreased length of stay in Swedish hospitals, an increasing delay of discharge has been observed among patients with long‐term care need. Aim Identify challenges and opportunities in the transition of patients between hospitals and out‐patient care. Method Data were obtained from national registers on patients discharged from hospitals in 2014, interviews with public care authorities, and a systematic literature review. Results A total of 1 121 823 persons were discharged from Swedish hospitals in 2014. Of all discharged patients, 334 420 (30%) was in need of further out‐patient medical care while 221 221 (20%) needed social services. Among these discharged patients, 53 763 (5%) needed both medical care and social services. In this group of frail persons (primarily females 80 years or older), 25 760 (48%) were readmitted to hospital within 30 days from the discharge. Main reported challenges in the transition were as follows: a decreasing number of beds in hospitals and nursing homes, lack of staff with proper education, and problems in transfer of information between caregivers. To solve these problems, respondents reported some new approaches: extensive initial home services after discharge, out‐patient care organised by both municipalities and county councils, local follow‐up of patient data as well as an emphasis on collaboration between caregivers. The literature reported ambiguous results about effects of single interventions at discharge. However, evidence suggests that the number of readmissions to hospital may be reduced by combining several interventions before discharge (individual planning, geriatric assessment, and patient education) with follow‐up after discharge. Conclusion Since many frail patients are readmitted to hospital within 30 days after discharge, Swedish out‐patient care may need new working methods in order to promote a coherent care. Further, multi‐component interventions at discharge, including follow‐up after discharge, may prevent unintended readmissions.

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“…But, the most recent Cochrane review [723] concludes that Home Hospitalization/Early Discharge is indicated for selected groups of elderly patients adding a degree of imprecision to the results for the main outcomes. Moreover, efficient care coordination after Home Hospitalization/Early Discharge is relevant, but it is often an unmet need.…”

Section: Discussionmentioning

confidence: 99%

“…We defined Home Hospitalization/Early Discharge as a service providing acute, home-based, short-term complex interventions aiming at substituting conventional hospitalization fully (Home Hospitalization) [2122] or partially (Early Discharge) [23]. The service was delivered by trained hospital personnel for a period of time that was not longer than the expected length of hospital stay for the patient’s diagnostic related groups involved [24].…”

Section: Theory and Methodsmentioning

confidence: 99%

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

Hernández¹,

Aibar²,

Seijas³

et al. 2018

Int J Integr Care

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Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored.Objective:To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona.Methods:Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients’ and professionals’ perspectives, technologies and costs were evaluated.Results:4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0–3) days and the length of home-based stay was 6 (5–7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services.Conclusions:The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.

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Early discharge hospital at home

Cited by 156 publications

References 107 publications

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

Discharge from hospital – a national survey of transition to out‐patient care

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

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