Cochrane examines the evidence base for the effectiveness and implementation of Hospital at Home programmes

Person getting care at home

A new Cochrane Library Editorial has been released following the publication of two Cochrane systematic reviews on Hospital at Home (HAH) programmes, urging a shift in the trajectory of HaH research. 

Hospital at Home provides hospital-level care at home, for people who would otherwise be inpatients in hospital. One type of Hospital at Home is to avoid admission to hospital. This is called Admission Avoidance Hospital at Home. These services replace an admission to hospital, for people whose condition would normally need treatment in a hospital bed, for example for a flare-up of a lung condition. Instead, a doctor can refer a patient they assess as being suitable to receive treatment for an illness in their own home (or the place where they usually live, including in residential care), for a limited time. Another type is called Early Discharge Hospital at Home. These services shorten the length of time people need to stay in hospital after being admitted as an inpatient, for example following surgery or treatment for an illness or condition. The care patients would usually receive from healthcare professionals in a hospital bed is instead provided in their home, and is not expected to compromise the quality of care.

'Hospital at home' services to avoid admission to hospital

This first Cochrane review examined if providing health care in an admission avoidance hospital at home setting improves patient health outcomes and reduces health service costs.

Edgar K, Iliffe S, Doll HA, Clarke MJ, Gonçalves-Bradley DC, Wong E, Shepperd S. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD007491. DOI: 10.1002/14651858.CD007491.pub3.

Multiple perceptions about implementing hospital at home

The second Cochrane review is a qualitative evidence synthesis on what is important when introducing, running, and receiving care from Hospital at Home services. The authors wanted to explore a range of experiences of, and views on, Admission Avoidance and Early Discharge services. Topics covered things that managers want to know when planning to set up a Hospital at Home service, healthcare professionals’ views on working in a Hospital at Home service, what matters to patients who receive this type of care, or how family and caregivers experience Hospital at Home services for those they care for.

Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014765. DOI: 10.1002/14651858.CD014765.pub2. 

These two updated Cochrane reviews demonstrate HaH's clinical and cost-effectiveness but also show the lack of effective scale-up strategies. An accompanying Cochrane Library editorial strongly suggests that the future direction of HaH research must move beyond repeating clinical and cost-effectiveness studies comparing HaH to usual care and instead focus on identifying and testing strategies to increase adoption and sustainability across different healthcare systems. 

The authors summarized the Cochrane Library Editorial by saying:

This editorial recognises the conclusive evidence that Hospital at Home (HaH) programmes are comparable to traditional hospital care, and encourages the  shift in the discourse from “does HaH work?” to “how to we scale up HaH successfully?”. 

Key challenges that needs to be addressed are: patient and  caregiver engagement, policy development, and sustainability to integrate HaH as a core component of acute care strtagies.

Lai YF, Ko SQ. Time to shift the research agenda for Hospital at Home from effectiveness to implementation. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: ED000165. DOI: 10.1002/14651858.ED000165.

Tuesday, March 5, 2024