What do we know about hospital at home? Lessons from international experience.

Hospital in the home' or 'hospital at home' services have become popular solutions to the apparent problems of conventional hospital care in many countries. Until recently their evaluation has been limited, and little has been known about their costs and benefits. A systematic review of randomised controlled trials of such services has failed to detect a difference in mortality and readmission rates of patients using hospital in the home, but does suggest that these services are acceptable to patients, although not necessarily to their carers. Important questions about professional roles and workloads in hospital at home services need further investigation. Overall it does not appear that such services produce cost savings, although this may depend greatly on local circumstances. This discussion paper uses the findings of a systematic review of the literature evaluating hospital at home and hospital in the home services to answer questions surrounding the supplementary or substitution status of these services.