Hospital at home early discharge

  • Review
  • Intervention




'Early discharge hospital at home' is a service that provides active treatment by health care professionals in the patient's home for a condition that otherwise would require acute hospital in-patient care. If hospital at home were not available then the patient would remain in an acute hospital ward.


To determine, in the context of a systematic review and meta-analysis, the effectiveness and cost of managing patients with early discharge hospital at home compared with in-patient hospital care.

Search methods

We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register , MEDLINE (1950 to 2008), EMBASE (1980 to 2008), CINAHL (1982 to 2008) and EconLit through to January 2008. We checked the reference lists of articles identified for potentially relevant articles.

Selection criteria

Randomised controlled trials recruiting patients aged 18 years and over. Studies comparing early discharge hospital at home with acute hospital in-patient care. Evaluations of obstetric, paediatric and mental health hospital at home schemes are excluded from this review.  

Data collection and analysis

Two authors independently extracted data and assessed study quality. Our statistical analyses were done on an intention-to-treat basis. We requested individual patient data (IPD) from trialists, and relied on published data when we did not receive trial data sets or the IPD did not include the relevant outcomes. For the IPD meta-analysis, where at least one event was reported in both study groups in a trial, Cox regression models were used to calculate the log hazard ratio and its standard error for mortality and readmission separately for each data set. The calculated log hazard ratios were combined using fixed-effect inverse variance meta-analysis.

Main results

Twenty-six trials were included in this review [n = 3967]; 21 were eligible for the IPD meta-analysis and 13 of the 21 trials contributed data [1899/2872; 66%]. For patients recovering from a stroke and elderly patients with a mix of conditions there was insufficient evidence of a difference in mortality between groups (adjusted HR 0.79, 95% CI 0.32 to 1.91; N = 494; and adjusted HR 1.06, 95% CI 0.69 to 1.61; N = 978). Readmission rates were significantly increased for elderly patients with a mix of conditions allocated to hospital at home (adjusted HR 1.57; 95% CI 1.10 to 2.24; N = 705). For patients recovering from a stroke and elderly patients with a mix of conditions respectively, significantly fewer people allocated to hospital at home were in residential care at follow-up (RR 0.63; 95% CI 0.40 to 0.98; N = 4 trials; RR 0.69, 95% CI 0.48 to 0.99; N =3 trials). Patients reported increased satisfaction with early discharge hospital at home. There was insufficient evidence of a difference for readmission between groups in trials recruiting patients recovering from surgery. Evidence on cost savings was mixed.

Authors' conclusions

Despite increasing interest in the potential of early discharge hospital at home services as a cheaper alternative to in-patient care, this review provides insufficient objective evidence of economic benefit or improved health outcomes.








我們檢索Cochrane Effective Practice and Organisation of Care (EPOC) Group Register,MEDLINE (1950至2008年),EMBASE (1980至2008年),CINAHL (1982至2008年)及EconLit至2008年1月。




兩名作者分別摘錄資料並評估研究品質。以意圖治療為基礎完成統計分析。我們向試驗人員要求個別的病患資料(individual patient data (IPD)),且當我們無法獲得試驗資料或個別病患資料中不包括相關結果時,則依據已發表的資料。關於IPD的統合分析,一篇試驗中兩個研究群體至少要報告一個結果事件,每一組資料使用Cox regression models分別計算死亡率及再住院的log hazard ratio及其standard error。採用變異數倒數固定效果的統合分析來合併log hazard ratios。


這篇回顧納入26篇試驗[n = 3967];合格的有21篇可進行IPD的統合分析,且其中13篇有提供資料[1899/2872;66%]。對於中風康復的病患及有混合症狀的老年病患,沒有足夠的證據顯示兩群體間其死亡率有差異(adjusted HR為0.79,95% CI為0.32至1.91;N = 494;且adjusted HR為1.06,95% CI為0.69至1.61;N = 978)。分配到居家醫療之混合症狀的老年病患其再住院率顯著增加(adjusted HR為1.57;95% CI為1.10至2.24;N = 705)。分別針對中風康復及混合症狀的老年病患,追蹤時顯示分配到居家醫療者顯著地較少人入住住宅式照護(RR為0.63;95% CI為0.40至0.98;N = 4篇試驗;RR為0.69,95% CI為0.48至0.99;N = 3篇試驗)。病患報告對於提早出院的居家照護滿意度增加。缺乏納入手術恢復病患其再住院率差異的足夠證據。節省成本的證據是複雜的。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Services for patients discharged home early

There continues to be, in some countries, more demand for acute care hospital beds than there are beds. One way to free up beds to make room for other people being admitted is to discharge patients home early. But the patients who are discharged still need acute care. Therefore, special home services have been developed. These services are usually provided by a team of health care professionals, such as doctors, nurses and physiotherapists. The team visits the home of people who have been discharged early to provide them with acute hospital care in their homes. 

A review of the effect of services for patients discharged home early was conducted. After searching for all relevant studies, 26 studies were identified. The studies looked at the effect of these services in patients with different types of conditions: patients who had a stroke, patients who had surgery, and elderly patients who had different types of conditions. 

There was insufficient evidence that providing services to people at home after being discharged home early may increase the risk of death or readmission; or adversely effect quality of life or the completion of daily activities (such as dressing or daily chores).  Patients who had a stroke or elderly patients may have less risk of being admitted to residential care if they are discharged home early with hospital at home services. 

Patients may also be more satisfied with their care at home, and at the same time their carers, in most cases, did not report additional burden. However, there is little evidence of cost savings to the health care system of discharging patients home early to hospital at home care.