Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data

Shepperd, Sasha; Doll, Helen; Angus, Robert M.; Clarke, Mike J.; Iliffe, Steve; Kalra, Lalit; Ricauda, Nicoletta Aimonio; Tibaldi, Vittoria; Wilson, Andrew D.
January 2009
CMAJ: Canadian Medical Association Journal;1/20/2009, Vol. 180 Issue 2, p175
Academic Journal
Background: Avoidance of admission through provision of hospital care at home is a scheme whereby health care professionals provide active treatment in the patient's home for a condition that would otherwise require inpatient treatment in an acute care hospital. We sought to compare the effectiveness of this method of caring for patients with that type of in-hospital care. Methods: We searched the MEDLINE, EMBASE, CINAHL and EconLit databases and the Cochrane Effective Practice and Organisation of Care Group register from the earliest date in each database until January 2008. We included randomized controlled trials that evaluated a service providing an alternative to admission to an acute care hospital. We excluded trials in which the program did not offer a substitute for inpatient care. We performed meta-analyses for trials for which the study populations had similar characteristics and for which common outcomes had been measured. Results: We included 10 randomized trials (with a total of 1327 patients) in our systematic review. Seven of these trials (with a total of 969 patients) were deemed eligible for metaanalysis of individual patient data, but we were able to obtain data for only 5 of these trials (with a total of 844 patients [87%]). There was no significant difference in mortality at 3 months for patients who received hospital care at home (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.54-1.09, p = 0.15). However, at 6 months, mortality was significantly lower for these patients (adjusted HR 0.62, 95% CI 0.45-0.87, p = 0.005). Admissions to hospital were greater, but not significantly so, for patients receiving hospital care at home (adjusted HR 1.49, 95% CI 0.96-2.33, p = 0.08). Patients receiving hospital care at home reported greater satisfaction than those receiving inpatient care. These programs were less expensive than admission to an acute care hospital ward when the analysis was restricted to treatment actually received and when the costs of informal care were excluded. Interpretation: For selected patients, avoiding admission through provision of hospital care at home yielded similar outcomes to inpatient care, at a similar or lower cost.


Related Articles

  • Telemedicine helps bridge gap between patients, care. Holzman, Paula // Central Penn Business Journal;4/24/2009, Vol. 25 Issue 17, p3 

    The article reports on the advantages of telemedicine centers to people in Pennsylvania. It states that the center enables medical professionals to track patients' health remotely via telephone and video-conferencing screens. It also lowers health care costs, allows home care agencies to provide...

  • Views of healthcare professionals to linkage of routinely collected healthcare data: a systematic literature review. Hopf, Y. M.; Bond, C.; Francis, J.; Haughney, J.; Helms, P. J. // Journal of the American Medical Informatics Association;Feb2014, Vol. 21 Issue e1, pe6 

    Objective To review the literature on the views of healthcare professionals to the linkage of healthcare data and to identify any potential barriers and/or facilitators to participation in a data linkage system. Methods Published papers describing the views of healthcare professionals (HCPs) to...

  • A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Dwyer, Rosamond; Gabbe, Belinda; Stoelwinder, Johannes U.; Lowthian, Judy // Age & Ageing;Nov2014, Vol. 43 Issue 6, p759 

    Background: residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a...

  • "Minimally invasive" lumbar spine surgery: a critical review. Payer, Michael // Acta Neurochirurgica;Jul2011, Vol. 153 Issue 7, p1455 

    Background: Minimal-access technology has evolved rapidly with "tubular" or "percutaneous" approaches for decompression and stabilization in the lumbar spine. Potential benefits (smaller scars, diminished local pain, reduced blood loss, reduced postoperative wound pain, shorter hospital stays)...

  • "Frequent flier" patients.  // BMJ: British Medical Journal (International Edition);4/16/2005, Vol. 330 Issue 7496, p869 

    Reports on a study conducted on "frequent flier" patients, who are admitted to the hospital three or more times in a given year. Statistics; Effect they had on health care costs.

  • Costos y resultados de la implementación de las guías de práctica clínica en la atención del ictus en dos hospitales de la Habana. Alina Turro Fuentes, Mercedes; García Fariñas, Anai; Gay Gómez, Mayda; María Gálvez González, Ana // Revista Cubana de Neurología y Neurocirugía;2013, Vol. 3 Issue 1, p30 

    Objective: To describe clinical outcomes and costs of patient management in acute phase using Cuban clinical practice guidelines in two health institutions in Havana. Methods: We performed a descriptive observational study, and from the axis of an economic evaluation was a description of costs...

  • Home care for child health promotion in Brazil: an integrative review. Monteiro de Moura, Talita Helena; Lucena de Vasconcelos, Maria Gorete; Pontes, Cleide Maria; Gomes Guedes, Tatiane; Barbosa Ximenes, Lorena; Pedrosa Leal, Luciana // Online Brazilian Journal of Nursing;Dec2014, Vol. 13 Issue 4, p686 

    Aim: To identify the care provided at home aimed at the promotion of child health in Brazil. Method: Integrative review of articles published in Portuguese, English and Spanish in MEDLINE, CINAHL and LILACS, using the descriptors infant, infant care, health promotion, family, child health and...

  • THE COST OF STAYING WELL. O'REILLY, EILEEN DRAGE // Trustee;Jan2009, Vol. 62 Issue 1, p20 

    The article explores wellness programs as a possible solution to burgeoning costs of staying well. Hospital-based wellness programs are discussed including those developed by large firms. Wellness initiatives for communities are presented along with the internal challenges faced by hospitals....

  • Incidence, Prevent ability, and Impact of Adverse Drug Events (ADEs) and Potential ADEs in Hospitalized Children in New Zealand. Kunac, Desireé L.; Kennedy, Julia; Austin, Nicola; Reith, David // Pediatric Drugs;2009, Vol. 11 Issue 2, p153 

    Background: Adverse drug events (ADEs) are an important problem in all hospitalized patients as these events represent medication-related patient harm. Few epidemiologic data exist regarding ADEs in the pediatric inpatient setting and, in particular, the economic impact of such ADEs upon the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics