Clinical question
What is the effectiveness and cost of managing patients in hospital-at-home settings compared with inpatient hospital care?
Bottom line
For an older population, admission-avoidance hospital at home probably makes little or no difference to the risk of death at 6 months’ follow-up, to the likelihood of being readmitted or requiring inpatient care within 3 to 12 months, and to self-reported health status. Hospital at home probably reduces the likelihood of relocating from home to residential care within 6 months, and it may increase patient satisfaction with healthcare received. Hospital at home probably reduces costs to the health service compared with hospital admission.
Hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of older people needing hospital admission.
Caveat
Increased satisfaction reported by patients must be balanced against the potential burden on caregivers (few studies reported the effect on caregivers). Hospital at home is not a complete substitute for hospital, and hospital admission must remain an option if required.
The success of hospital at home also rests on the level of primary care available and the enthusiasm of local clinicians and healthcare managers. Some of these studies ran hospital at home as an outreach programme from hospital, while others ran it by supplementing existing primary care services.
Context
Admission-avoidance hospital at home provides active treatment by healthcare professionals in the patient’s home. This should be for a condition that would otherwise require acute hospital inpatient care for a limited time.
Possible benefits of these services include releasing hospital beds, reducing the risk of adverse events associated with time in hospital, minimising loss of independence and improving patient satisfaction and communication.
Cochrane Systematic Review
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