The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

Mäkelä, Petra; Stott, David J.; Godfrey, Mary; Ellis, Graham; Schiff, Rebekah; Shepperd, Sasha

doi:10.1093/ageing/afaa085

Cited by 30 publications

(92 citation statements)

References 25 publications

(19 reference statements)

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“…The majority of the studies were from America or Europe ( n =15) 1 , 12 , 20 – 32 . A third of these studies were based in the UK ( n =5) 24 – 27 , 32 and one was in Australia 33 . Studies were qualitative ( n =14) 1 , 12 , 20 – 24 , 26 – 31 , 33 , or mixed-methods ( n =2) 25 , 32 .…”

Section: Resultsmentioning

confidence: 99%

“…The remaining study employed open-ended questionnaire 29 . Studies employed thematic analysis ( n =9) 12 , 21 , 22 , 24 – 26 , 30 , 32 , 33 , content analysis ( n =3) 23 , 28 , 29 , ground theory analysis ( n =2) 1 , 20 , normalizing process theory analysis ( n =1) 27 , or retrospective analysis ( n =1) 31 . Most HaH provided early discharge ( n =9) 12 , 22 , 25 , 26 , 28 – 31 , 33 compared to admission avoidance ( n =1) 27 , while the remaining studies did not specify.…”

Section: Resultsmentioning

confidence: 99%

“…Studies employed thematic analysis ( n =9) 12 , 21 , 22 , 24 – 26 , 30 , 32 , 33 , content analysis ( n =3) 23 , 28 , 29 , ground theory analysis ( n =2) 1 , 20 , normalizing process theory analysis ( n =1) 27 , or retrospective analysis ( n =1) 31 . Most HaH provided early discharge ( n =9) 12 , 22 , 25 , 26 , 28 – 31 , 33 compared to admission avoidance ( n =1) 27 , while the remaining studies did not specify. The HaH studies included patients who had multiple diagnosis ( n =6) 1 , 12 , 20 , 23 , 30 , 32 , COPD ( n =3) 24 , 29 , 31 , cancer ( n =1) 33 , renal diseases ( n =1) 22 , and mental illnesses ( n =1) 26 , and also geriatric ( n =2) 21 , 27 and orthopedic patients ( n =2) 25 , 28 .…”

Section: Resultsmentioning

confidence: 99%

“…Most HaH provided early discharge ( n =9) 12 , 22 , 25 , 26 , 28 – 31 , 33 compared to admission avoidance ( n =1) 27 , while the remaining studies did not specify. The HaH studies included patients who had multiple diagnosis ( n =6) 1 , 12 , 20 , 23 , 30 , 32 , COPD ( n =3) 24 , 29 , 31 , cancer ( n =1) 33 , renal diseases ( n =1) 22 , and mental illnesses ( n =1) 26 , and also geriatric ( n =2) 21 , 27 and orthopedic patients ( n =2) 25 , 28 . All HaH involved multidisciplinary teams or units, and some involved community service providers (e.g., community healthcare practitioners, community nurses, community social care managers, healthcare agency partnerships) 1 , 12 , 23 , 24 , 27 – 30 , 33 .…”

Section: Resultsmentioning

confidence: 99%

“…The HaH studies included patients who had multiple diagnosis ( n =6) 1 , 12 , 20 , 23 , 30 , 32 , COPD ( n =3) 24 , 29 , 31 , cancer ( n =1) 33 , renal diseases ( n =1) 22 , and mental illnesses ( n =1) 26 , and also geriatric ( n =2) 21 , 27 and orthopedic patients ( n =2) 25 , 28 . All HaH involved multidisciplinary teams or units, and some involved community service providers (e.g., community healthcare practitioners, community nurses, community social care managers, healthcare agency partnerships) 1 , 12 , 23 , 24 , 27 – 30 , 33 . Table 1 summarizes the studies’ characteristics and Table 2 depicts the types of participants interviewed.…”

Section: Resultsmentioning

confidence: 99%

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Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Chua

Lai

et al. 2021

J GEN INTERN MED

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Background Hospital-at-home (HaH) provides acute healthcare in patients’ homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care. Methodology Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso’s guidelines. Results Sixteen articles met the inclusion criteria. The overarching synthesized theme was “the intricacies of developing HaH,” and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development. Conclusion Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07065-0.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Chua

Lai

et al. 2021

J GEN INTERN MED

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Discharge planning from hospital

Gonçalves‐Bradley

Lannin

Clemson

et al. 2022

Cochrane Database of Systematic Reviews

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BackgroundDischarge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fi h update of the original review. ObjectivesTo assess the e ectiveness of planning the discharge of individual patients moving from hospital. Search methodsWe searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies. Selection criteriaRandomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients. Data collection and analysisTwo review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) for continuous data using fixed-e ect meta-analysis. When combining outcome data it was not possible because of di erences in the reporting of outcomes, we summarised the reported results for each trial in the text. Main resultsWe included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD − 0.73, 95% confidence interval (CI) − 1.33 to − 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 Discharge planning from hospital (Review)

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Admission avoidance hospital at home

Edgar,

Iliffe,

Doll

et al. 2024

Cochrane Database of Systematic Reviews

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Background Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that would otherwise require acute hospital inpatient care, and always for a limited time period. This is the fourth update of this review. Objectives To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL on 24 February 2022, and checked the reference lists of eligible articles. We sought ongoing and unpublished studies by searching ClinicalTrials.gov and WHO ICTRP, and by contacting providers and researchers involved in the field. Selection criteria Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. Data collection and analysis We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta‐analysis for trials that compared similar interventions, reported comparable outcomes with sufficient data, and used individual patient data when available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. Main results We included 20 randomised controlled trials with a total of 3100 participants; four trials recruited participants with chronic obstructive pulmonary disease; two trials recruited participants recovering from a stroke; seven trials recruited participants with an acute medical condition who were mainly older; and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. For an older population, admission avoidance hospital at home probably makes little or no difference on mortality at six months' follow‐up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.68 to 1.13; P = 0.30; I 2 = 0%; 5 trials, 1502 participants; moderate‐certainty evidence); little or no difference on the likelihood of being readmitted to hospital after discharge from hospital at home or inpatient care within 3 to 12 months' follow‐up (RR 1.14, 95% CI 0.97 to 1.34; P = 0.11; I 2 = 41%; 8 trials, 1757 participants; moderate‐certainty evidence); and probably reduces the likelihood of living in residential care at six months' follow‐up (RR 0.53, 95% CI 0.41 to 0.69; P < 0.001; I 2 = 67%; 4 trials, 1271 participants; moderate‐certainty evidence). Hospital at home probably results in l...

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The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

Cited by 30 publications

References 25 publications

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Discharge planning from hospital

Admission avoidance hospital at home

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