Mounting evidence for efficacy and cost savings
Over the last decade or so the concept of hospital-in-the-home (HITH) has become a reality with conditions treated becoming more complex and acute.
This article will look at the home management of two conditions that traditionally have been treated in hospitals as well as explore the cost-effectiveness of HITH.
Community-acquired pneumonia
Richard and colleagues studied outcomes associated with home versus hospital care of patients with mild-to-moderate community-acquired pneumonia1, finding that the median number of days to “discharge” was 4 in the HITH group compared with 2 in the hospital group (P=0.004).
There were no significant differences in the number days spent on IV or oral antibiotics At 2 weeks, there were no significant differences in patient-rated symptoms or time to resolution of fever, tachycardia and tachypnoea; however, significantly more patients complained of occasional sleep disturbance in the HITH group. This difference did not persist at 6 weeks. Physical and mental functioning according to the Short-Form 12 was similar amongst both groups. Complications had a similar frequency and pattern. Significantly more patients in the HITH group were satisfied with their care as well as the location of their care.
Pulmonary embolism
A retrospective Australian study looked at 130 patients with pulmonary embolism (PE) treated in the home setting, 46% of whom were treated totally as outpatients. Three episodes of major bleeding occurred, all in patients aged older than 70 years. Four patients died within in 3 months, but none in the first week with none of these deaths being attributable to PE. There were seven cases of recurrent venous thromboembolic disease.
The authors concluded that appropriately selected patients with submassive PE can be treated in the home. A well-defined protocol for home management eligibility and close medical supervision is needed.
HITH reduces costs
In the New Zealand-based study by Richards and colleagues, home care cost around 75% of the caseweight-based cost of hospital care. In a randomised controlled trial of patients presenting to an Australian emergency department, 49 patients with acute medical conditions were admitted to hospital, while 51 were treated at home. The HITH group’s cost per separation was significantly lower than the hospital group’s (P<0.0001) with no significant difference in outcomes and comparable or better levels of patient satisfaction.