Benefits Of Hospital At Home Unclear For Early Discharge Patients

Ruzanna Harutyunyan's picture
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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.

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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.

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