Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence

Abstract

Objectives: To evaluate the efficacy of hospital at home schemes compared with inpatient care in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

Design: A systematic review of randomised controlled trials.

Main outcome measure: Mortality and readmission to hospital.

Results: Seven trials with 754 patients were included in the review. Hospital readmission and mortality were not significantly different when hospital at home schemes were compared with inpatient care (relative risk 0.89, 95% confidence interval 0.72 to 1.12, and 0.61, 0.36 to 1.05, respectively). However, compared with inpatient care, hospital at home schemes were associated with substantial cost savings as well as freeing up hospital inpatient beds.

Conclusions: Hospital at home schemes can be safely used to care for patients with acute exacerbations of COPD who would otherwise be admitted to hospital. Clinicians should consider this form of management, especially as there is increasing pressure for inpatient beds in the United Kingdom.

Fig 1

Results of search for trials and reasons for excluding studies

Fig 2

Relative risk for readmission to hospital, calculated with fixed effect model with 95% confidence intervals. Square box indicates relative risk for each trial with line representing 95% confidence interval

Fig 3

Details of trials included for mortality outcome