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A meta-analysis of “hospital in the home”

Med J Aust 2012; 197 (9): 512-519. || doi: 10.5694/mja12.10480

Summary

Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.

Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012.

Study selection: Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years.

Data extraction: Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist.

Data synthesis: 61 RCTs met the inclusion criteria. HITH care led to reduced mortality (odds ratio [OR], 0.81; 95% CI, 0.69 to 0.95; P = 0.008; 42 RCTs with 6992 patients), readmission rates (OR, 0.75; 95% CI, 0.59 to 0.95; P = 0.02; 41 RCTs with 5372 patients) and cost (mean difference, 1567.11; 95% CI, 2069.53 to 1064.69; P < 0.001; 11 RCTs with 1215 patients). The number needed to treat at home to prevent one death was 50. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies; carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00; 95% CI, 0.19 to 0.19).

Conclusion: HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden.

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  • Gideon A Caplan1,2
  • Nur S Sulaiman3
  • Dee A Mangin4
  • Nicoletta Aimonino Ricauda5
  • Andrew D Wilson6
  • Louise Barclay1

  • 1 Post Acute Care Services, Prince of Wales Hospital, Sydney, NSW.
  • 2 Prince of Wales Clinical School, University of New South Wales, Sydney, NSW.
  • 3 Queen Elizabeth Hospital, Adelaide, SA.
  • 4 School of Public Health and General Practice, Christchurch School of Medicine, Christchurch, New Zealand.
  • 5 Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, University of Torino, Torino, Italy.
  • 6 Department of Health Sciences, University of Leicester, Leicester, UK.

Correspondence: g.caplan@unsw.edu.au

Acknowledgements: 

This study was supported by an unrestricted grant from the Julianna Lowy Foundation, which had no role in the study design, data analysis or writing of this article.

Competing interests:

Gideon Caplan and Nicoletta Aimonino Ricauda work in a hospital and a HITH unit. Louise Barclay works in a HITH unit.

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