F S F Ram1, J A Wedzicha, J Wright, M Greenstone. 1. National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, 27, Sussex Place, Regent's Park, London, UK, NW1 4RG.
Abstract
BACKGROUND: Hospital 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. OBJECTIVES: To evaluate the efficacy of "hospital at home" compared to hospital inpatient care in acute exacerbations of chronic obstructive pulmonary disease. SEARCH STRATEGY: The 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 CRITERIA: Only 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 ANALYSIS: Two reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data. MAIN RESULTS: Seven 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. REVIEWER'S CONCLUSIONS: This 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.
BACKGROUND: Hospital 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. OBJECTIVES: To evaluate the efficacy of "hospital at home" compared to hospital inpatient care in acute exacerbations of chronic obstructive pulmonary disease. SEARCH STRATEGY: The 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 CRITERIA: Only 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 ANALYSIS: Two reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data. MAIN RESULTS: Seven 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. REVIEWER'S CONCLUSIONS: This 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.
Authors: Anna Svarre Jakobsen; Lars C Laursen; Susan Rydahl-Hansen; Birte Østergaard; Thomas Alexander Gerds; Christina Emme; Lone Schou; Klaus Phanareth Journal: Telemed J E Health Date: 2015-02-05 Impact factor: 3.536
Authors: Cecile M A Utens; Lucas M A Goossens; Frank W J M Smeenk; Onno C P van Schayck; Walter van Litsenburg; Annet Janssen; Monique van Vliet; Wiel Seezink; Dirk R A J Demunck; Brigitte van de Pas; Peter J de Bruijn; Anouschka van der Pouw; Jeroen M A M Retera; Petra de Laat-Bierings; Loes van Eijsden; Maria Braken; Riet Eijsermans; Maureen P M H Rutten-van Mölken Journal: BMC Public Health Date: 2010-10-18 Impact factor: 3.295
Authors: Cecile M A Utens; J A M Maarse; Onno C P van Schayck; Boudewijn L P Maesen; Maureen P M H Rutten; Frank W J M Smeenk Journal: Int J Integr Care Date: 2012-05-18 Impact factor: 5.120
Authors: Chris D Bailey; Richard Wagland; Rasha Dabbour; Ann Caress; Jaclyn Smith; Alex Molassiotis Journal: BMC Pulm Med Date: 2010-12-09 Impact factor: 3.317
Authors: Jacques Lemelin; William E Hogg; Simone Dahrouge; Catherine Deri Armstrong; Carmel M Martin; Wei Zhang; Jo-Anne Dusseault; Joy Parsons-Nicota; Raphael Saginur; Gary Viner Journal: BMC Health Serv Res Date: 2007-08-17 Impact factor: 2.655