Hospital in the home: what next?

Wilson, Andrew D; Parker, Stuart G

doi:10.5694/j.1326-5377.2005.tb07023.x

Topics

It is time to focus on issues of roll-out and quality control

“Hospital in the home” can mean different things in different countries and contexts. A Cochrane review defined it as “a service that provides active treatment . . . in the patient’s home of a condition that otherwise would require acute hospital in-patient care”.1 This definition includes services that substitute acute care by home-based management (admission avoidance) and those that support discharge with community-based post-acute care and rehabilitation (discharge support). The review found “insufficient evidence to support expansion or contraction” of home-based alternatives to inpatient hospital care.1 Two articles in this issue of the Journal contribute to the clinical evidence base for home care as an admission-avoidance service.

1 Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
2 Sheffield Institute for Studies on Ageing, University of Sheffield, Barnsley, United Kingdom.

Correspondence:

1. Shepperd S. Hospital at home versus in-patient hospital care. Cochrane Database Syst Rev 2001; CD000356.
2. Richards DA, Toop LJ, Epton MJ, et al. Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial. Med J Aust 2005; 183: 235-238. <MJA full text>
3. Ong B, Karr M, Chan D, et al. Management of pulmonary embolism in the home. Med J Aust 2005; 183: 239-242. <MJA full text>
4. Corwin P, Toop L, McGeoch G, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005; 330: 129.
5. Ram FS, Wedzicha JA, Wright J, Greenstone M. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2003; CD003573.
6. Schraibman IG, Milne AA, Royle EM. Home versus in-patient treatment for deep vein thrombosis. Cochrane Database Syst Rev 2001; CD003076.
7. Harris R, Ashton T, Broad J, et al. The effectiveness, acceptability and costs of a hospital-at-home service compared with acute hospital care: a randomized controlled trial. J Health Serv Res Policy 2005; 10: 158-166.
8. MacIntyre CR, Ruth D, Ansari Z. Hospital in the home is cost saving for appropriately selected patients: a comparison with in-hospital care. Int J Qual Health Care 2002; 14: 285-293.
9. Hospital in the home. Victorian Government Health Information. Available at: http://www.health.vic.gov.au/hith/ (accessed Jun 2005).
10. National service framework for older people. London: Department of Health, 2001.
11. National Beds Enquiry. Shaping the future NHS: long term planning for hospitals and related services. London: Department of Health, 2000.
12. Martin GP, Peet SM, Hewitt GJ, Parker H. Diversity in intermediate care. Health Soc Care Community 2004; 12: 150-154.
13. Evans JG, Tallis RC. A new beginning for care for elderly people? Not if the psychopathology of this national service framework gets in the way. BMJ 2001; 322: 807-808.
14. Wilson A, Parker H. Intermediate care and general practitioners: an uncertain relationship. Health Soc Care Community 2003; 11: 81-84.

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