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'Hospital-at-home' concept does not save money or improve outcomes, study finds

Although patients generally prefer to be home instead of the hospital to recover from serious illness, a new review of studies finds that "hospital-at-home" programs common in Europe and Australia do not save money and may not affect health outcomes very much.

The review also shows that the higher patient satisfaction may be offset by evidence that the burden on caregivers is greater.

The review, an update of previous studies on the subject, appears in the July of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Led by Sasha Shepperd, Ph.D, of Oxford University, the review combines results from 22 individual hospital-at-home studies that measure various outcomes including mortality, patient satisfaction, psychological well-being, caregiver satisfaction and readmission rates "Available data does suggest hospital at home services increase patient satisfaction compared with hospital care," the researchers concluded, but "the view of carers was mixed."

The hospital-at-home concept provides treatment by health care professions at a patient's home for an acute condition that would otherwise require at least a short-term hospital stay. The idea is to reduce expenditures by national health systems.

"Despite increasing interest in the potential of hospital at home services as a cheaper alternative to in-patient care, this review provides insufficient objective evidence of economic benefit," the authors found, as they had in a previous smaller review.

One effect they did find was that while the hospital-at-home reduced how long a patient stayed in a hospital at the outset of an illness, the overall length of care increased for the patients treated at home, possibly negating overall savings
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Contact: Sasha Shepperd
sasha.shepperd@continuing-education.oxford.ac.uk
Center for the Advancement of Health
19-Jul-2005


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