|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
Hospital at home for acute exacerbations of chronic obstructive pulmonary diseaseRam FSF, Wedzicha JA, Wright JJ, Greenstone M
Bookmark this:
     more ...
SummaryThe effects of early discharge schemes in people who have had COPD exacerbationsThis review of "hospital at home" service has shown that patients presenting to hospital emergency departments with acute exacerbations of chronic obstructive pulmonary disease can be successfully treated at home when supported by visiting respiratory nurses at home. This review found no evidence of differences between "hospital at home" patients and hospital inpatients for readmission rates and mortality at two to three months after the initial exacerbation. Both patients and carers preferred "hospital at home" care to inpatient care. However, only one in four patients were suitable for "hospital at home" schemes.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 20. 2003 AbstractBackgroundHospital at home schemes are a recently adopted method of service delivery for the management of acute exacerbations of chronic obstructive pulmonary disease aimed at reducing demand for acute hospital in-patient beds and promoting a patient centered approach through admission avoidance. However, evidence in support of such a service is contradictory. ObjectivesTo evaluate the efficacy of "hospital at home" compared to hospital inpatient care in acute exacerbations of chronic obstructive pulmonary disease. Search strategyThe Cochrane Central Register of Controlled Trials; electronically available databases e.g. MEDLINE (1966-current), EMBASE (1980-current), PubMed, ClincalTrials, Science Citation Index and on-line individual respiratory journals; bibliographies of included trials were all searched and contact with authors was made to obtain studies. The most recent searches were carried out in August 2003. Selection criteriaOnly randomised controlled trials were considered where patients presented to the emergency department with an exacerbation of their chronic obstructive pulmonary disease. Studies must not have recruited patients that are usually deemed obligatory admissions. Data collection and analysisTwo reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data. Main resultsSeven studies with 754 patients were included in the review. Studies provided data on hospital readmission and mortality both of which were not significantly different when the two study groups were compared (RR 0.89; 95%CI 0.72 to 1.12 & RR 0.61; 95%CI 0.36 to 1.05, respectively). Both the patients and the carers preferred hospital at home schemes to inpatient care (RR 1.53; 95%CI 1.23 to 1.90). Other reported outcomes included few studies. Authors' conclusionsThis review has shown that one in four carefully selected patients presenting to hospital emergency departments with acute exacerbations of chronic obstructive pulmonary disease can be safely and successfully treated at home with support from respiratory nurses. This review found no evidence of significant differences between "hospital at home" patients and hospital inpatients for readmission rates and mortality at two to three months after the initial exacerbation. Both the patients and carers preferred "hospital at home" schemes to inpatient care. |