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Benefits
of “Hospital at Home” unclear for Early
Discharge Patients
Newswise — Faced with a shortage of beds and costly patient
care, some hospitals are turning to programs
that provide acute care for patients at
home.
However, there is not yet enough
information to know whether these “hospital
at home” programs improve health and reduce
costs for patients discharged early from the
hospital, according to a new research
review.
A few such programs exist in the United States, including
one developed by Johns Hopkins researchers
in 2002.
After analyzing 26 studies of early discharge patients
recovering from a stroke, surgery or a mix
of conditions, University of Oxford
researcher Sasha Shepperd and colleagues say
it’s unclear whether hospital-at-home
programs increase or reduce the risk of
death or readmission to the hospital.
However, stroke patients and older patients with a mix of
medical conditions who participated in a
hospital-at-home program were less likely to
be in nursing home care six months after the
program ended, the researchers found.
Early discharge patients were also more satisfied with
their care than those who remained in the
hospital, but “there is little evidence of
cost savings to the health care system of
discharging patients early to
hospital-at-home care,” Shepperd said.
Most of the studies analyzed for the review occurred in the
United Kingdom.
The review appears in the latest issue of The Cochrane
Library, a publication of The Cochrane
Collaboration, an international organization
that evaluates medical research.
Systematic reviews like this one draw evidence-based
conclusions about medical practice after
considering both the content and quality of
existing medical trials on a topic.
Unlike programs that discharge a patient with instructions
to care for herself, or those that send a
nurse or other health care worker to the
home for follow-up care, hospital-at-home
programs provide acute care that normally
would take place in a hospital.
Patients usually receive daily visits from a doctor, and
can receive services such as X-rays,
electrocardiograms or intravenous medication
at home.
The Cochrane review “does not support the widespread
development of early discharge
hospital-at-home services” as a less
expensive alternative to regular hospital
care, but the programs examined by the
researchers do not appear to be "so overly
expensive or harmful to patients that
existing programs should be discontinued,”
Shepperd said.
Some hospital-at-home programs might also relieve a
caregiver’s burdens, said Bruce Leff, M.D.,
an associate professor of medicine at The
Johns Hopkins University School of Medicine,
and one of the developers of the American
Hospital at HomeSM model program.
“We have studied the issue of caregiver stress and have
found that it is lower for family members of
hospital-at-home patients than for typical
hospital patients,” Leff said, while noting
that not all hospital-at-home programs
eliminate the need for non-professional care
at home.
The American Hospital at Home program is in use at
Presbyterian Healthcare Services in
Albuquerque, N.M., and the Portland Veteran
Affairs Medical Center in Oregon.
The Cochrane Collaboration is an international nonprofit,
independent organization that produces and
disseminates systematic reviews of health
care interventions and promotes the search
for evidence in the form of clinical trials
and other studies of interventions. Visit
http://www.cochrane.org for more
information.
Shepperd S, et al. Early discharge hospital at home
(Review). The Cochrane Database of
Systematic Reviews 2009, Issue 1.
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