Shepperd S, Iliffe S
Division of Public Health and Primary Care, University of Oxford.
J Public Health Med. 1998 Sep;20(3):344-50. doi: 10.1093/oxfordjournals.pubmed.a024778.
Despite the widespread adoption of hospital at home services it is not known if these services represent an effective way to manage patients, compared with in-patient hospital care.
A systematic review was carried out of randomized controlled trials comparing hospital at home care with acute hospital in-patient care for patients age 18 years and over, excluding those with long-term care needs, obstetric patients, and those requiring mental health services. The following databases were searched: Medline, Embase, Social Science Citation Index, CINAHL, EconLit, PsychLit, SIGLE, Medical Care supplement on economic literature, and the EPOC (Cochrane Effective Practice and Organization of Care Review Group) register. Data were extracted for the following outcomes: mortality, clinical complications, re-admissions, costs, hospital days saved from the provision of hospital at home, discharge destination from hospital at home, functional status, psychological well-being, patient satisfaction and carer satisfaction. Data analysis and quality assessment were undertaken independently by two reviewers using a data checklist, following standard methods described by the EPOC group.
Five trials were included in the review. 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, which recruited patients requiring terminal care, formally tested for a difference in cost. No statistically significant difference was detected for overall net health costs.
This review does not support the widespread adoption of hospital at home, nor the discontinuation of existing schemes for elderly medical patients, patients who have had elective surgery, or those with a terminal illness. There is insufficient evidence to determine the effect of hospital at home on patient outcomes, or cost to the health service.
尽管居家医院服务已被广泛采用，但与住院治疗相比，这些服务是否是管理患者的有效方式尚不清楚。
对18岁及以上患者的居家医院护理与急性住院治疗进行比较的随机对照试验进行了系统评价，排除了有长期护理需求的患者、产科患者和需要心理健康服务的患者。检索了以下数据库：医学索引数据库（Medline）、荷兰医学文摘数据库（Embase）、社会科学引文索引、护理学与健康领域数据库（CINAHL）、经济学文献数据库（EconLit）、心理学文摘数据库（PsychLit）、灰色文献数据库（SIGLE）、经济文献医学护理增刊以及循证护理有效实践与护理组织审查组（EPOC）登记册。提取了以下结局的数据：死亡率、临床并发症、再入院率、成本、因提供居家医院服务而节省的住院天数、居家医院的出院目的地、功能状态、心理健康、患者满意度和护理人员满意度。两名评审员按照EPOC组描述的标准方法，使用数据清单独立进行数据分析和质量评估。
该评价纳入了五项试验。未发现患者健康结局有统计学显著差异。择期手术后从医院提前出院到居家医院的患者对护理的满意度高于留在医院的患者。然而，与住院护理相比，护理人员对居家医院的满意度较低。只有一项招募了需要临终护理患者的试验正式测试了成本差异。未发现总体净健康成本有统计学显著差异。
本评价不支持广泛采用居家医院服务，也不支持停止针对老年内科患者、接受择期手术的患者或患有绝症的患者的现有方案。没有足够的证据来确定居家医院服务对患者结局或卫生服务成本的影响。
