Study looks at hospital at-home programs

For select patients, hospital at home treatment produces similar outcomes to inpatient care at similar or lower costs, found a study by researchers from the United Kingdom and Italy to be published in CMAJ.

Hospital at home programs are popular alternatives to hospital stays given the demand for acute care beds and the need to cut costs.

The study, a systematic review and meta-analysis, sought to determine whether patients receiving at home care compared with in-patient hospital care have better or equivalent health outcomes. It looked at trials of patients 70 years of age or older with chronic pulmonary disease (COPD), stroke patients and older patients with acute medical conditions.

"Patients allocated to hospital at home had a significantly reduced risk of death at 6 months follow up," state Dr. Sasha Shepperd and coauthors. "This reduction was not significant at 3 months, possibly reflecting the lower number of events by that time point." They note patient satisfaction was high for treatment at home.

However, mortality rates were lower at 3 months for patients in hospital stroke care units compared with hospital at home care.

"Our findings do not mean that hospital care is hazardous," cautions Dr. Shepperd who led the team of researchers. "More work needs to be done to determine if there are particular types of patients who benefit from hospital at home care. This is especially important, as the level of treatment available to a person at home, and the ways of delivering care in both the home and the hospital, change."

Professor Mike Clarke, another member of the research team, from the UK Cochrane Centre, adds "We are also cautious because we had to rely on data from trials that have been published, and we were not able to find any unpublished trials. It may be that other research has taken place and that the trials we identified are not representative of all those that have been done. However, our findings still represent the most complete analysis yet of this topic and provide important knowledge for patients, doctors and policy makers."

The study was conducted by researchers from University of Oxford; University Hospital Aintree Hospitals NHS Trust; University College, London; King's & St. Thomas' School of Medicine; University of Leicester; and University of Torino, Italy.

In a related commentary http://www.cmaj.ca/press/pg156.pdf, Dr. Bruce Leff of Johns Hopkins University School of Medicine writes: "We must incorporate hospital at home into the continuum of care without it becoming yet another siloed health care delivery model." He suggests hospital at home could operate as one element in a portfolio of options to keep select patients out of hospital and to help patients' transition from hospital.