Hospital at Home: The Evidence Is Not Compelling

Many countries are exploring alternatives to inpatient care because of increasing health care costs, pressure on acute hospital beds, and concern that inpatient care may not produce the best health outcomes for some groups of patients. Developments in medical technology, improvements in housing, and an increasing emphasis on primary care have all encouraged innovations that reduce reliance on inpatient care (1, 2). Hospital at home provides health care for patients who would otherwise require a hospital stay. Patients may use hospital at home after early discharge from the hospital or directly after assessment in the emergency department or in a physician's office. Hospital at home comes in several flavors, which vary according to the admission criteria, utilization of technology, organizational structure, and funding arrangements.

There is a substantial body of evidence to inform us about hospital-at-home care. A systematic review of 22 randomized, controlled trials of hospital-at-home care concluded that patients who received this type of care had outcomes that were similar to those who were treated in the hospital (3). Although some evidence suggests that patient satisfaction may be higher for those who receive hospital-at-home care, the burden on family caretakers can also be greater. According to the evidence, hospital-at-home care does not produce cost savings as viewed from the perspective of a health care organization. However, most trials included in this systematic review were small, so the meta-analysis was underpowered to detect differences in mortality and readmission rates. Therefore, an important reduction or increase in these outcomes is still consistent with the evidence. …