Plain language summary ‘Hospital at home’ services to avoid admission to hospital What is the aim of this review? The aim of this Cochrane Review was to find out if providing health care in an admission avoidance hospital at home setting improves patient health outcomes and reduces health service costs. Key messages Admission avoidance hospital at home probably makes little or no difference to risk of death; probably increases the chances of living at home at six months’ follow‐up; and may be slightly less expensive. What was studied in this review? There continues to be more demand for acute hospital beds than there are beds available. One way to reduce reliance on hospital beds is to provide people with acute health care at home, sometimes called ‘admission avoidance hospital at home’. In contrast, ‘early discharge hospital at home’ refers to patients being discharged early from hospital to be treated at home; this topic has been reviewed separately. What did we want to find out? We wanted to find out if hospital at home makes a difference to patient health outcomes and to living independently at home. We also wanted to find out if it was less expensive than hospital care, and if it affects length of stay in treatment and patient satisfaction. What did we do? We searched for studies that compared hospital at home treatment for an acute health event with inpatient hospital care. We compared and summarised the results of the studies, and rated our confidence in the evidence based on factors such as study methods and sizes. What did we find? We found 20 studies, of which four were identified for this update, with a total of 3100 patients with a range of acute conditions. Four studies recruited participants with chronic obstructive (lung) disease; two studies recruited participants recovering from a stroke; seven studies recruited participants with a (sudden or short‐term) medical condition who were mainly older; and the remaining studies recruited participants with a mix of conditions. When compared to in‐hospital care, admission avoidance hospital at home services for a select group of patients probably make little or no difference to risk of death or to the likelihood of being taken to hospital in the next 3 to 12 months, and probably increase the chances of living at home at six months’ follow‐up. Patients who receive care at home may have increased satisfaction compared to those in hospital; however, the effects of this type of care on the caregivers who support them are unclear. Hospital at home probably results in little to no difference in patients’ health status. Hospital at home decreases the amount of time patients spend in hospital, while length of stay in hospital at home tended to be longer than a typical hospital stay. Admission avoidance hospital at home probably decreases treatment costs, though by a range of different amounts. What are the limitations of the evidence? Due to the small size of most of the studies, we are moderately confident that admission avoidance hospital at home does not make a difference to the number of people who died when compared to in‐hospital care. Our confidence in the evidence for readmission and living in residential care was reduced to moderate because the lengths of follow‐up differed among studies. We are moderately confident in the evidence for patient‐reported health status, as participants were aware of which treatment they were getting, which could have influenced the results. We have little confidence in the evidence on patient satisfaction because not many studies reported this outcome, and on length of stay because length of stay varied across studies. We are moderately confident in the evidence for cost because only three trials looked at this fully. How up‐to‐date is the review? We searched for studies published up to February 2022.
【저자키워드】 Hospitalization, hospitals, humans, Patient discharge, home care services, health facilities, Inpatients,