Acceptability of early discharge, hospital at home schemes
Year: 1998
Type: article
Abstract: Editor—Richards et al’s and Shepperd et al’s definitions of what constitutes hospital in the home care are problematic.1,2 Richards et al described hospital in the home as “a generic term, referring to a package of home based nursing and rehabilitation services,” while Shepperd et al restricted the eligible groups of patient to patients older than 60 with five broadly defined conditions.
Our concern with these studies is that patients seem to have been selected on the basis of their clinical condition and its burden on the hospital rather than on the basis that their acute hospital based treatment could be appropriately delivered at home. We also wonder whether the selection of conditions for study was determined by the presence of validated research instruments
The appropriate definition of hospital in the home is one in which the patient requires treatment that, without the presence of a hospital in the home delivery system, would otherwise require care in hospital. Substitution of hospital in the home care for acute hospital care is the critical element. In the above papers, the length of stay data showed that the hospital in the home component was additional to the hospital stay rather than a substitute for it.
It is a pity that both papers chose not to consider non-British publications in their discussions, since considerable activity has occurred outside Britain. In Australia hospital in the home programmes provide acute treatment such as intravenous treatment (giving antibiotics, chemotherapy, inotropes, blood products), giving dalteparin for deep venous thrombosis, and complex postoperative wound care.3–5 Increasingly, patients are admitted to hospital in the home care directly from the emergency department and are considered inpatients in every sense other than that their care is provided at home.5 The hospital retains clinical, fiscal, and legal responsibility for the pharmaceutical input, medical supervision, and nursing care of hospital in the home patients.
Without firm clinical definitions to ensure substitution, cost comparisons are of little value. Most descriptive studies, however, have found cost savings with hospital in the home care if patients are selected carefully.5
The challenge for the future of hospital in the home is to determine which types of treatment in which patient groups can be safely, effectively, and acceptably managed at home and which are the best models for delivering quality outcomes. Trials will need to be clear about the nature of the intervention if they are to be helpful in the future.
Source: BMJ
Authors: M Montalto, M L Grayson
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W126709065