Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data
(2009)
Journal - Canadian Medical Association Journal
Abstract :
Background: Avoidance of admission through provision of hospitalcare at home is a scheme whereby health care professionals provideactive treatment in the patient's home for a condition thatwould otherwise require inpatient treatment in an acute carehospital. We sought to compare the effectiveness of this methodof caring for patients with that type of in-hospital care.Methods: We searched the MEDLINE, EMBASE, CINAHL and EconLitdatabases and the Cochrane Effective Practice and Organisationof Care Group register from the earliest date in each databaseuntil January 2008. We included randomized controlled trialsthat evaluated a service providing an alternative to admissionto an acute care hospital. We excluded trials in which the programdid not offer a substitute for inpatient care. We performedmeta-analyses for trials for which the study populations hadsimilar characteristics and for which common outcomes had beenmeasured.Results: We included 10 randomized trials (with a total of 1327patients) in our systematic review. Seven of these trials (witha total of 969 patients) were deemed eligible for meta-analysisof individual patient data, but we were able to obtain datafor only 5 of these trials (with a total of 844 patients [87%]).There was no significant difference in mortality at 3 monthsfor patients who received hospital care at home (adjusted hazardratio [HR] 0.77, 95% confidence interval [CI] 0.54–1.09,p = 0.15). However, at 6 months, mortality was significantlylower for these patients (adjusted HR 0.62, 95% CI 0.45–0.87,p = 0.005). Admissions to hospital were greater, but not significantlyso, for patients receiving hospital care at home (adjusted HR1.49, 95% CI 0.96–2.33, p = 0.08). Patients receivinghospital care at home reported greater satisfaction than thosereceiving inpatient care. These programs were less expensivethan admission to an acute care hospital ward when the analysiswas restricted to treatment actually received and when the costsof informal care were excluded.Interpretation: For selected patients, avoiding admission throughprovision of hospital care at home yielded similar outcomesto inpatient care, at a similar or lower cost.