Shepperd S, Iliffe S
Department of General Practice, Imperial College of Science, Technology & Medicine, St Mary's Campus, Norfolk Place, London, UK, W2 1PG.
Cochrane Database Syst Rev. 2000(2):CD000356. doi: 10.1002/14651858.CD000356.
Hospital-at-home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. Hospital-at-home has become a popular response to the increasing demand for acute hospital beds.
To assess the effects of hospital-at-home compared with in-patient hospital care for patients.
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register, MEDLINE to 1996, EMBASE to 1995, Cinahl to 1996, the Social Science Citation Index (1992 to 1995), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995), the Medical Care supplement on economic literature (1979 to 1990), and reference lists of articles.
Randomised trials of hospital-at-home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. The outcomes were mortality, clinical complications, re-admissions, cost (to the patient and family, to general practice, to the hospital and to the community), hospital days saved from the provision of hospital-at-home, discharge destination from hospital-at-home, general and disease specific health status, functional status, psychological well-being, patient satisfaction, carer satisfaction, carer burden, and staff views (including the satisfaction of doctors working in primary care).
Two reviewers independently extracted data and assessed study quality.
Five studies were included involving 866 patients. All studies were small and lacked power. No statistically significant differences were detected for patient health outcomes. Patients discharged early from hospital to hospital-at-home following elective surgery expressed greater satisfaction with care than those who remained in hospital. Carers however expressed less satisfaction with hospital-at-home compared with hospital care. Only one trial formally tested for a difference in cost, with no statistically significant difference detected for overall health care costs.
REVIEWER'S CONCLUSIONS: There is insufficient evidence to assess the effects of hospital-at-home on patient outcomes or the cost to the health service. Given the heterogeneity of what hospital-at-home encompasses and the uncertainty over its effects, future research should clearly specify the type of service being provided, both at home and at hospital, and the specific patient groups. Patient health outcomes, patient and carer satisfaction, and costs should be measured, and studies should include a formal, planned economic analysis. Studies should be large enough to detect important differences and to ensure generalisability of the results.
居家医院护理是指医护人员在患者家中对原本需要急性住院治疗的疾病进行积极治疗的一种服务，且通常为期有限。居家医院护理已成为应对急性医院病床需求不断增加的一种流行方式。
评估居家医院护理与住院医院护理相比对患者的影响。
我们检索了Cochrane有效实践与护理组织小组专业注册库、Cochrane对照试验注册库、截至1996年的MEDLINE、截至1995年的EMBASE、截至1996年的Cinahl、社会科学引文索引（1992年至1995年）、经济文献数据库（1969年至1996年）、心理学文摘数据库（1987年至1996年）、科技文献灰色文献数据库（1980年至1995年）、医学护理经济文献增刊（1979年至1990年）以及文章的参考文献列表。
居家医院护理与急性住院医院护理对比的随机试验。参与者为18岁及以上的患者。结局指标包括死亡率、临床并发症、再次入院率、成本（对患者及其家庭、全科医疗、医院和社区而言）、因提供居家医院护理而节省的住院天数、居家医院护理后的出院去向、一般和特定疾病的健康状况、功能状态、心理健康、患者满意度、护理者满意度、护理者负担以及工作人员的看法（包括初级保健医生的满意度）。
两名评价员独立提取数据并评估研究质量。
纳入了五项研究，涉及866名患者。所有研究规模都较小且效能不足。在患者健康结局方面未检测到统计学上的显著差异。择期手术后提前出院至居家医院护理的患者对护理的满意度高于仍留在医院的患者。然而，与住院护理相比，护理者对居家医院护理的满意度较低。只有一项试验正式检验了成本差异，在总体医疗保健成本方面未检测到统计学上的显著差异。
尚无足够证据评估居家医院护理对患者结局或卫生服务成本的影响。鉴于居家医院护理所涵盖内容的异质性及其效果的不确定性，未来研究应明确规定在家中和医院所提供服务的类型以及特定患者群体。应衡量患者健康结局、患者和护理者满意度以及成本，研究应包括正式的、有计划的经济分析。研究规模应足够大，以检测出重要差异并确保结果具有可推广性。
