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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1999 Apr 20;160(8):1151–1155.

The health and cost effects of substituting home care for inpatient acute care: a review of the evidence

L Soderstrom 1, P Tousignant 1, T Kaufman 1
PMCID: PMC1230267  PMID: 10234345

Abstract

BACKGROUND: There is much interest in reducing hospital stays by providing some health care services in patients' homes. The authors review the evidence regarding the effects of this acute care at home (acute home care) on the health of patients and caregivers and on the social costs (public and private costs) of managing the patients' health conditions. METHODS: MEDLINE and HEALTHSTAR databases were searched for articles using the key term "home care." Bibliographies of articles read were checked for additional references. Fourteen studies met the selection criteria (publication between 1975 and early 1998, evaluation of an acute home care program for adults, and use of a control group to evaluate the program). Of the 14, only 4 also satisfied 6 internal validity criteria (patients were eligible for home care, comparable patients in home care group and hospital care group, adequate patient sample size, appropriate analytical techniques, appropriate health measures and appropriate costing methods). RESULTS: The 4 studies with internal validity evaluated home care for 5 specific health conditions (hip fracture, hip replacement, chronic obstructive pulmonary disease [COPD], hysterectomy and knee replacement); 2 of the studies also evaluated home care for various medical and surgical conditions combined. Compared with hospital care, home care had no notable effects on patients' or caregivers' health. Social costs were not reported for hip fracture. They were unaffected for hip and knee replacement, and higher for COPD and hysterectomy; in the 2 studies of various conditions combined, social costs were higher in one and lower in the other. Effects on health system costs were mixed, with overall cost savings for hip fracture and higher costs for hip and knee replacement. INTERPRETATION: The limited existing evidence indicates that, compared with hospital care, acute home care produces no notable difference in health outcomes. The effects on social and health system costs appear to vary with condition. More well-designed evaluations are needed to determine the appropriate use of acute home care.

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Selected References

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  1. Adler M. W., Waller J. J., Creese A., Thorne S. C. Randomised controlled trial of early discharge for inguinal hernia and varicose veins. J Epidemiol Community Health. 1978 Jun;32(2):136–142. doi: 10.1136/jech.32.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Coast J., Richards S. H., Peters T. J., Gunnell D. J., Darlow M. A., Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ. 1998 Jun 13;316(7147):1802–1806. doi: 10.1136/bmj.316.7147.1802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Donald I. P., Baldwin R. N., Bannerjee M. Gloucester hospital-at-home: a randomized controlled trial. Age Ageing. 1995 Sep;24(5):434–439. doi: 10.1093/ageing/24.5.434. [DOI] [PubMed] [Google Scholar]
  4. Dougherty G. E., Soderstrom L., Schiffrin A. An economic evaluation of home care for children with newly diagnosed diabetes: results from a randomized controlled trial. Med Care. 1998 Apr;36(4):586–598. doi: 10.1097/00005650-199804000-00014. [DOI] [PubMed] [Google Scholar]
  5. Farnworth M. G., Kenny P., Shiell A. The costs and effects of early discharge in the management of fractured hip. Age Ageing. 1994 May;23(3):190–194. doi: 10.1093/ageing/23.3.190. [DOI] [PubMed] [Google Scholar]
  6. Fenton F. R., Tessier L., Contandriopoulos A. P., Nguyen H., Struening E. L. A comparative trial of home and hospital psychiatric treatment: financial costs. Can J Psychiatry. 1982 Apr;27(3):177–187. doi: 10.1177/070674378202700301. [DOI] [PubMed] [Google Scholar]
  7. Ferris F. D., Wodinsky H. B., Kerr I. G., Sone M., Hume S., Coons C. A cost-minimization study of cancer patients requiring a narcotic infusion in hospital and at home. J Clin Epidemiol. 1991;44(3):313–327. doi: 10.1016/0895-4356(91)90043-9. [DOI] [PubMed] [Google Scholar]
  8. Gerson L. W., Collins J. F. A randomized controlled trial of home care: clinical outcome for five surgical procedures. Can J Surg. 1976 Nov;19(6):519–523. [PubMed] [Google Scholar]
  9. Gerson L. W., Hughes O. P. A comparative study of the economics of home care. Int J Health Serv. 1976;6(4):543–555. doi: 10.2190/WQKT-FUJ8-278F-P0X6. [DOI] [PubMed] [Google Scholar]
  10. Hensher M., Fulop N., Hood S., Ujah S. Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients. J R Soc Med. 1996 Oct;89(10):548–551. doi: 10.1177/014107689608901003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hollingworth W., Todd C., Parker M., Roberts J. A., Williams R. Cost analysis of early discharge after hip fracture. BMJ. 1993 Oct 9;307(6909):903–906. doi: 10.1136/bmj.307.6909.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hughes S. L., Cummings J., Weaver F., Manheim L. M., Conrad K. J., Nash K. A randomized trial of Veterans Administration home care for severely disabled veterans. Med Care. 1990 Feb;28(2):135–145. doi: 10.1097/00005650-199002000-00004. [DOI] [PubMed] [Google Scholar]
  13. Knowelden J., Westlake L., Wright K. G., Clarke S. J. Peterborough Hospital at Home: an evaluation. J Public Health Med. 1991 Aug;13(3):182–188. doi: 10.1093/oxfordjournals.pubmed.a042616. [DOI] [PubMed] [Google Scholar]
  14. O'Cathain A. Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur. J Public Health Med. 1994 Jun;16(2):205–210. doi: 10.1093/oxfordjournals.pubmed.a042958. [DOI] [PubMed] [Google Scholar]
  15. Parker M. J., Pryor G. A., Myles J. W. Early discharge after hip fracture. Prospective 3-year study of 645 patients. Acta Orthop Scand. 1991 Dec;62(6):563–566. doi: 10.3109/17453679108994497. [DOI] [PubMed] [Google Scholar]
  16. Pineault R., Contandriopoulos A. P., Valois M., Bastian M. L., Lance J. M. Randomized clinical trial of one-day surgery. Patient satisfaction, clinical outcomes, and costs. Med Care. 1985 Feb;23(2):171–182. doi: 10.1097/00005650-198502000-00008. [DOI] [PubMed] [Google Scholar]
  17. Pryor G. A., Williams D. R. Rehabilitation after hip fractures. Home and hospital management compared. J Bone Joint Surg Br. 1989 May;71(3):471–474. doi: 10.1302/0301-620X.71B3.2722942. [DOI] [PubMed] [Google Scholar]
  18. Richards S. H., Coast J., Gunnell D. J., Peters T. J., Pounsford J., Darlow M. A. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ. 1998 Jun 13;316(7147):1796–1801. doi: 10.1136/bmj.316.7147.1796. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Ruckley C. V., Cuthbertson C., Fenwick N., Prescott R. J., Garraway W. M. Day care after operations for hernia or varicose veins: a controlled trial. Br J Surg. 1978 Jul;65(7):456–459. doi: 10.1002/bjs.1800650704. [DOI] [PubMed] [Google Scholar]
  20. Shepperd S., Harwood D., Gray A., Vessey M., Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ. 1998 Jun 13;316(7147):1791–1796. doi: 10.1136/bmj.316.7147.1791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Shepperd S., Harwood D., Jenkinson C., Gray A., Vessey M., Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ. 1998 Jun 13;316(7147):1786–1791. doi: 10.1136/bmj.316.7147.1786. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stiver H. G., Telford G. O., Mossey J. M., Cote D. D., van Middlesworth E. J., Trosky S. K., McKay N. L., Mossey W. L. Intravenous antibiotic therapy at home. Ann Intern Med. 1978 Nov;89(5 Pt 1):690–693. doi: 10.7326/0003-4819-89-5-690. [DOI] [PubMed] [Google Scholar]
  23. Stiver H. G., Trosky S. K., Cote D. D., Oruck J. L. Self-administration of intravenous antibiotics: an efficient, cost-effective home care program. Can Med Assoc J. 1982 Aug 1;127(3):207–211. [PMC free article] [PubMed] [Google Scholar]
  24. Strauss M. J., Gong J., Gary B. D., Kalsbeek W. D., Spear S. The cost of home air-fluidized therapy for pressure sores. A randomized controlled trial. J Fam Pract. 1991 Jul;33(1):52–59. [PubMed] [Google Scholar]
  25. Talcott J. A., Whalen A., Clark J., Rieker P. P., Finberg R. Home antibiotic therapy for low-risk cancer patients with fever and neutropenia: a pilot study of 30 patients based on a validated prediction rule. J Clin Oncol. 1994 Jan;12(1):107–114. doi: 10.1200/JCO.1994.12.1.107. [DOI] [PubMed] [Google Scholar]
  26. Wade D. T., Langton-Hewer R., Skilbeck C. E., Bainton D., Burns-Cox C. Controlled trial of a home-care service for acute stroke patients. Lancet. 1985 Feb 9;1(8424):323–326. doi: 10.1016/s0140-6736(85)91091-8. [DOI] [PubMed] [Google Scholar]

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