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Review
. 2017 Jun 26;6(6):CD000356.
doi: 10.1002/14651858.CD000356.pub4.

Early discharge hospital at home

Daniela C Gonçalves-Bradley  1 , Steve Iliffe, Helen A Doll, Joanna Broad, John Gladman, Peter Langhorne, Suzanne H Richards, Sasha Shepperd
Affiliations
Review

Early discharge hospital at home

Daniela C Gonçalves-Bradley et al. Cochrane Database Syst Rev. .

Abstract

Background: Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review.

Objectives: To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care.

Search methods: We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries.

Selection criteria: Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes. DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes.

Main results: We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI 0.40 to 0.98; N = 574, 4 trials, low-certainty evidence) and might slightly improve patient satisfaction (N = 795, low-certainty evidence). Hospital at home probably reduces hospital length of stay, as moderate-certainty evidence found that people assigned to hospital at home are discharged from the intervention about seven days earlier than people receiving inpatient care (95% CI 10.19 to 3.17 days earlier, N = 528, 4 trials). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people with a mix of medical conditionsEarly discharge hospital at home probably makes little or no difference to mortality (RR 1.07, 95% CI 0.76 to 1.49; N = 1247, 8 trials, moderate-certainty evidence). In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people undergoing elective surgeryThree studies did not report higher rates of mortality with hospital at home compared with inpatient care (data not pooled, N = 856, low-certainty evidence; mainly orthopaedic surgery). Hospital at home may lead to little or no difference in readmission to hospital for people who were mainly recovering from orthopaedic surgery (N = 1229, low-certainty evidence). We could not establish the effects of hospital at home on the risk of living in institutional care, due to a lack of data. The intervention might slightly improve patient satisfaction (N = 1229, low-certainty evidence). People recovering from orthopaedic surgery allocated to early discharge hospital at home were discharged from the intervention on average four days earlier than people allocated to usual inpatient care (4.44 days earlier, 95% CI 6.37 to 2.51 days earlier, , N = 411, 4 trials, moderate-certainty evidence). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).

Authors' conclusions: Despite increasing interest in the potential of early discharge hospital at home services as a less expensive alternative to inpatient care, this review provides insufficient evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

PubMed Disclaimer

Conflict of interest statement

DGB: none known

SI: none known

HAD: none known

JB: none known

JG: none known

PL: none known

SHR: none known

SS: none known

JB, JG, SHR and SS were investigators on five of the included trials. These authors were not involved in the risk of bias assessment of their own trials. All GRADE judgements were debated with review authors not involved in trials.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 1: Mortality at 3 ‐ 6 months
1.3
1.3. Analysis
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 3: Hospital readmission at 3 ‐ 6 months
1.7
1.7. Analysis
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 7: Institutional care at 6 months follow‐up (Rodgers 3‐month data)
1.10
1.10. Analysis
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 10: Hospital length of stay
2.1
2.1. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1: Mortality at 3 ‐ 6 months ‐ older people with a mix of conditions
2.2
2.2. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2: Mortality ‐ chronic obstructive pulmonary disease
2.3
2.3. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3: Hospital readmission at 3 months ‐ older people with a mix of conditions
2.4
2.4. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 4: Hospital readmission for those with COPD
2.6
2.6. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 6: Functional status at 3 months ‐ older people with a mix of conditions
2.8
2.8. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 8: Institutional care at 1 year follow‐up (Donald 6 months) ‐ older patients with a mix of conditions
2.14
2.14. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 14: Hospital length of stay ‐ older people with a mix of conditions
2.15
2.15. Analysis
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 15: Total length of stay ‐ older people with a mix of mainly medical conditions
3.9
3.9. Analysis
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 9: Hospital length of stay ‐ older people recovering from surgery
3.11
3.11. Analysis
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 11: Total length of stay ‐ older people having elective surgery
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Adler 1978 {published data only}
    1. Adler MW, Waller JJ, Creese A, Thorne SC. Randomised controlled trial of early discharge for inguinal hernia and varicose veins. Journal of Epidemiology and Community Health 1978;32(2):136-42. - PMC - PubMed
Anderson 2000 {published data only}
    1. Anderson C, Mhurchu CN, Rubenach S, Clark M, Spencer C, Winsor A. Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: II: cost minimization analysis at 6 months. Stroke 2000;31(5):1032-7. - PubMed
    1. Anderson C, Rubenach S, Mhurchu CN, Clark M, Spencer C, Winsor A. Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: I: health outcomes at 6 months. Stroke 2000;31(5):1024-31. - PubMed
Askim 2004 {published data only}
    1. Askim T, Rohweder G, Lydersen S, Indredavik B. Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial. Clinical Rehabilitation 2004;18:238-48. - PubMed
Bautz‐Holter 2002 {published and unpublished data}
    1. Bautz-Holter E, Sveen U, Rygh J, Rodgers H, Wyller TB. Early supported discharge of patients with acute stroke: a randomized controlled trial. Disability and Rehabilitation 2002;24(7):348-55. - PubMed
Booth 2004 {published data only}
    1. Booth JE, Roberts JA, Flather M, Lamping DL, Mister R, Abdalla M, et al. A trial of early discharge with homecare compared to conventional hospital care for patients undergoing coronary artery bypass grafting. Heart 2004;90(11):1344-5. - PMC - PubMed
Caplan 2006 {published data only}
    1. Caplan GA, Coconis J, Board N, Sayers A, Woods J. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age and Ageing 2006;35(1):53-60. - PubMed
Cotton 2000 {published data only}
    1. Cotton MM, Bucknall CE, Dagg KD, Johnson MK, MacGregor G, Stewart C, et al. Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial. Thorax 2000;55(11):902-6. - PMC - PubMed
Crotty 2002 {published data only}
    1. Crotty M, Whitehead CH, Gray S, Finucane PM. Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomised controlled trial. Clinical Rehabiliation 2002;16(4):406-13. - PubMed
Cunliffe 2004 {published and unpublished data}
    1. Cunliffe A, Gladman JRF, Husbands SL, Miller P, Dewey ME, Harwood RH. Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people. Age and Ageing 2004;33(3):246-52. - PubMed
Díaz Lobato 2005 {published data only}
    1. Díaz Lobatoa S, González Lorenzo F, Gómez Mendieta MA, Mayoralas Alises S, Martín Arechabala I, Villasante Fernández-Montes C. Evaluation of a home hospitalisation program in patients with COPD exacerbations [Evaluación de un programa de hospitalización domiciliaria en pacientes con EPOC agudizada]. Archivos de Bronconeumologia 2005;41(1):5-10. - PubMed
Donald 1995 {published data only}
    1. Donald IP, Baldwin RN, Bannerjee M. Gloucester hospital-at-home: a randomized controlled trial. Age and Ageing 1995;24(5):434-9. - PubMed
Donnelly 2004 {published and unpublished data}
    1. Donnelly M, Power M, Russell M, Fullerton K. Randomised controlled trial of an early discharge rehabilitation service: the Belfast Community Stroke Trial. Stroke 2004;35(1):127-33. - PubMed
Harris 2005 {published and unpublished data}
    1. Harris R, Ashton T, Broad J, Connolly G, Richmond D. The effectiveness, acceptability and costs of a hospital-at-home service compared with acute hospital care: a randomized controlled trial. Journal of Health Services and Research Policy 2005;10(3):158-66. - PubMed
Ince 2014 {published data only}
    1. Ince AT, Senturk H, Singh VK, Yildiz K, Danalioğlu A, Cinar A, et al. A randomized controlled trial of home monitoring versus hospitalization for mild non-alcoholic acute interstitial pancreatitis: a pilot study. Pancreatology 2014;14(3):174-8. [DOI: 10.1016/j.pan.2014.02.007] - DOI - PubMed
Indredavik 2000 {published data only}
    1. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Benefit of an extended stroke unit service with early supported discharge: A randomized, controlled trial. Stroke 2000;31(12):2989-2994. - PubMed
Karlsson 2016 {published data only}
    1. Karlsson A, Berggren M, Gustafson Y, B Olofsson, Lindelöf N, Stenvall M. Effects of geriatric interdisciplinary home rehabilitation on walking ability and length of hospital stay after hip fracture: A randomized controlled trial. Journal of the American Medical Directors Association 2016;17(5):464.e9-e464.e15. [DOI: 10.1016/j.jamda.2016.02.001] - DOI - PubMed
Manchester FASTER {unpublished data only}
    1. Dey P, Woodman M. FASTER Trial group. Data on file 2006.
Martin 1994 {published and unpublished data}
    1. Martin F, Oyewole A, Moloney A. A randomized controlled trial of a high support hospital discharge team for elderly people. Age and Ageing 1994;23(3):228-34. - PubMed
Mayo 2000 {published and unpublished data}
    1. Mayo NE, Wood-Dauphinee S, Cote R, Gayton D, Carlton J, Buttery J, et al. There's no place like home: an evaluation of early supported discharge for stroke. Stroke 2000;31(5):1016-23. - PubMed
    1. Teng J, Mayo NE, Latimer E, Hanley J, Wood-Dauphinee S, Côté R, et al. Costs and caregiver consequences of early supported discharge for stroke patients. Stroke 2003;34(2):528-36. - PubMed
Ojoo 2002 {published data only}
    1. Ojoo JC, Moon T, McGlone S, Martin K, Gardiner ED, Greenstone MA, et al. Patients' and carers' preferences in two models of care for acute exacerbations of COPD: results of a randomised controlled trial. Thorax 2002;57(2):167-9. - PMC - PubMed
Palmer Hill 2000 {published data only}
    1. Palmer Hill S, Flynn J, Crawford EJP. Early discharge following total knee replacement - a trial of patient satisfaction and outcomes using an orthopaedic outreach team. Journal of Orthopaedic Nursing 2000;4:121-6.
Rada 2008 {unpublished data only}
    1. Rada G. Effectiveness, costs and user satisfaction in home hospitalisation as a model for early discharge from the hospital, in patients with low to moderate risk [Eficacia, costos y satisfacción usuaria de la hospitalización en domicilio como modelo de alta precoz desde el hospital, en pacientes de riesgo bajo y moderado]. Santiago, Chile: Fondo Nacional de Investigación y Desarrollo en Salud - FONIS. Report No.: SA08I20007 2008.
Richards 1998 {published and unpublished data}
    1. Coast J, Richards SH, Peters TJ, Gunnell DJ, Darlow MA, Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ 1998;316(7147):1802-6. - PMC - PubMed
    1. Gunnell D, Coast J, Richards S, Peters T, Pounsford J, Darlow M. How great a burden does early discharge to hospital-at-home impose on carers? A randomized controlled trial. Age and Ageing 2000;29(2):137-42. - PubMed
    1. Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow MA. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ 1998;316(7147):1796-801. - PMC - PubMed
Rodgers 1997 {published and unpublished data}
    1. McNamee P, Christensen J, Soutter J, Rodgers H, Craig N, Pearson P. Cost analysis of early supported hospital discharge for stroke. Age and Ageing 1998;27:345-51.
    1. Rodgers H, Soutter J, Kaiser W, Pearson P, Dobson R, Skilbeck C, et al. Early supported hospital discharge following acute stroke: pilot study results. Clinical Rehabilitation 1997;11(4):280-7. - PubMed
Ruckley 1978 {published data only}
    1. Ruckley CV, Cuthbertson C, Fenwick N, Prescott RJ, Garraway WM. Day care after operations for hernia or varicose veins: a controlled trial. British Journal of Surgery 1978;65(7):456-9. - PubMed
Rudd 1997 {published and unpublished data}
    1. Beech R, Rudd A, Tilling K, Wolfe C. Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke 1999;30(4):729-35. - PubMed
    1. Rudd AG, Wolfe CD, Tilling K, Beech R. Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ 1997;315(7115):1039-44. - PMC - PubMed
Shepperd 1998 {published and unpublished data}
    1. Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ 1998;316(7147):1791-6. - PMC - PubMed
    1. Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ 1998;316(7147):1786-91. - PMC - PubMed
Skwarska 2000 {published data only}
    1. Skwarska E, Cohen G, Skwarski KM, Lamb C, Bushell D, Parker S, et al. Randomised controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary disease. Thorax 2000;55(11):907-12. - PMC - PubMed
Suwenwela 2001 {published data only}
    1. Suwanwela NC, Phanthumchinda K, Limtongkul S, Suvanprakorn P. Thai Red Cross Volunteers Bureau. Comparison of short (3-day) hospitalization followed by home care treatment and conventional (10-day) hospitalization for acute ischemic stroke. Cerebrovascular Disease 2002;13(4):267-71. - PubMed
Tibaldi 2013 {published data only}
    1. Tibaldi V, Isaia G, Bergerone S, Moiraghi C, Gariglio F, Marchetto C, et al. A randomized clinical trial on the efficacy of an early discharge to a hospital at home service of elderly patients with acute decompensation of severe chronic heart failure [Studio clinico randomizzato sull’efficacia della dimissione precoce in ospedalizzazione a domicilio di pazienti anzianicon scompenso cardiaco cronico avanzato riacutizzato]. Giornale di Gerontologia 2013;61:69-73.
Utens 2012 {published data only}
    1. Utens CM, Goossens LM, Smeenk FW, Rutten-van Mölken MP, Van Vliet M, Braken MW, et al. Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: Results of a randomised controlled trial. BMJ Open 2012;2(5):pii: e001684. [DOI: 10.1136/bmjopen-2012-001684] - DOI - PMC - PubMed
    1. Utens CM, Goossens LM, Smeenk FW, Van Schayck OC, Van Litsenburg W, Janssen A, et al. Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: The design of a randomised controlled trial. BMC Public Health 2010;10:618. [DOI: 10.1186/1471-2458-10-618] - DOI - PMC - PubMed
    1. Utens CM, Goossens LM, Smeenk FW, Van Schayck OC, Van Litsenburg W, Janssen A, et al. Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: The design of a randomised controlled trial. BMC Public Health 2010;10:618. [DOI: 10.1186/1471-2458-10-618] - DOI - PMC - PubMed
    1. Utens CM, Goossens LM, Van Schayck OC, Rutten-van Mölken MP, Van Litsenburg W, Janssen A, et al. Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial. International Journal of Nursing Studies 2013;50(11):1537-49. [DOI: 10.1016/j.ijnurstu.2013.03.006] - DOI - PubMed
    1. Utens CM, Van Schayck OC, Goossens LM, Rutten-van Mölken MP, DeMunck DR, Seezink W, et al. Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial. International Journal of Nursing Studies 2014;51(8):1093-102. [DOI: 10.1016/j.ijnurstu.2014.01.002] - DOI - PubMed
Widén Holmqvist 1998 {published and unpublished data}
    1. Von Koch L, Widén Holmqvist L, Kostulas V, Almazán J, Pedro-Cuesta J. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm: outcome at 6 months. Scandinavian Journal of Rehabilitation Medicine 2000;32(2):80-6. - PubMed
    1. Widén Holmqvist L, Von Koch L, Kostulas V, Holm M, Widsell G, Tegler H, et al. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke 1998;29(3):591-7. - PubMed

References to studies excluded from this review

Belagaje 2014 {published data only}
    1. Belagaje SR, Zander K, Thackeray L, Gupta R. Disposition to home or acute rehabilitation is associated with a favorable clinical outcome in the SENTIS trial. Journal of Neurointerventional Surgery 2015;7(5):322-5. [DOI: 10.1136/neurintsurg-2014-011132] - DOI - PubMed
Bonnema 1998 {published data only}
    1. Bonnema J, Van Wersch A, Van Geel A, Pruyn J, Schmitz PIM, Uyl-de-Groot CA, et al. Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer. European Journal of Cancer 1998;34:2015-20. - PubMed
Bove 2015 {published data only}
    1. Bove DG, Overgaard D, Lomborg K, Lindhardt BØ, Midtgaard J. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol. BMJ Open 2015;5(7):e008031. [DOI: 10.1136/bmjopen-2015-008031] - DOI - PMC - PubMed
Brooten 1994 {published data only}
    1. Brooten D, Roncoli M, Finkler S, Arnold L, Cohen A, Mennuti M. A randomized trial of early hospital discharge and home follow-up of women having cesarean birth. Obstetrics and Gynecology 1994;84(5):832-8. - PMC - PubMed
Buhagiar 2017 {published data only}
    1. Buhagiar MA, Naylor JM, Harris IA, Zuan W, Kohler F, Wright R, et al. Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial. JAMA 2017;317(10):1037-46. - PubMed
Bundred 1998 {published data only}
    1. Bundred N, Maguire P, Reynolds J, Grimshaw J, Morris J, Thomson L, et al. Randomised controlled trial of effects of early discharge after surgery for breast cancer. BMJ 1998;317(7168):1275-9. - PMC - PubMed
Collins 2014 {published data only}
    1. Collins AM, Eneje OJ, Hancock CA, Wootton DG, Gordon SB. Feasibility study for early supported discharge in adults with respiratory infection in the UK. BMC Pulmonary Medicine 2014;14:25. [DOI: 10.1186/1471-2466-14-25] - DOI - PMC - PubMed
Cruz Eng 2015 {published data only}
    1. Cruz Eng H, Riazi S, Veillette C, Ami N, Niazi AU, Chin KJ, et al. An expedited care pathway with ambulatory brachial plexus analgesia is a cost-effective alternative to standard inpatient care after complex arthroscopic elbow surgery: a randomized, single-blinded study. Anesthesiology 2015;123(6):1256-66. [DOI: 10.1097/ALN.0000000000000852] - DOI - PubMed
Faucher 2012 {published data only}
    1. Faucher C, Le Corroller Soriano AG, Esterni B, Vey N, Stoppa AM, Chabannon C, et al. Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs. Bone Marrow Transplantation 2012;47(4):549-55. [DOI: 10.1038/bmt.2011.126] - DOI - PubMed
Fjaertoft 2011 {published data only}
    1. Fjaetoft H, Rohweder G, Indredavik B. Stroke unit care combined with early supported discharge improves 5-year outcome: A randomized controlled trial. Stroke 2011;42(6):1707-11. [DOI: 10.1161/STROKEAHA.110.601153] - DOI - PubMed
Gerson 1976 {published data only}
    1. Gerson LW, Berry AF. Psycho-social effects of home care: results of a randomized controlled trial. International Journal of Epidemiology 1976;5(2):159-65. - PubMed
Gjelsvik 2014 {published data only}
    1. Gjelsvik BEB, Hofstad H, Smedal T, Eide GE, Naess H, Skouen JS, et al. Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home,and traditional treatment (control). BMJ Open 2014;4(5):e004358. [DOI: 10.1136/bmjopen-2013-004358] - DOI - PMC - PubMed
Hansen 1992 {published data only}
    1. Hansen FR, Spedtsberg K, Schroll M. Geriatric follow-up by home visits after discharge from hospital: a randomized controlled trial. Age and Ageing 1992;21(6):445-50. - PubMed
Hernandez 2003 {published data only}
    1. Hernandez C, Casas A, Escarrabill J, Alonso J, Puig-Junoy J, Farrero E, et al, CHRONIC project. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. European Respiratory Journal 2003;21(1):58-67. - PubMed
Hill 1978 {published data only}
    1. Hill JD, Hampton JR, Mitchell JR. A randomised trial of home-versus-hospital management for patients with suspected myocardial infarction. Lancet 1978;1(8069):837-41. - PubMed
Hofstad 2014 {published data only}
    1. Hofstad H, Gjelsvik BE, Naess H, Eide GE, Skouen JS. Early supported discharge after stroke in Bergen (ESD Bergen): three and six month results of a randomised controlled trial comparing two early supported discharge schemes with treatment as usual.. BMC Neurology 2014;14(239):DOI: 19.1186/s12883-014-0239-3. - PMC - PubMed
Koopman 1996 {published data only}
    1. Koopman MM, Prandoni P, Piovella F, Ockelford PA, Brandjes DP, Van der Meer J, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. New England Journal of Medicine 1996;334(11):682-7. - PubMed
Levine 1996 {published data only}
    1. Levine M, Gent M, Hirsh J, Leclerc J, Anderson D, Weitz J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. New England Journal of Medicine 1996;334(11):677-81. - PubMed
Magid 1989 {published data only}
    1. Magid DM, Vokes EE, Schilsky RL, Guarnieri CM, Whaling SM, Weichselbaum RR, et al. A randomized study of inpatient versus outpatient continuous intravenous infusion chemotherapy: psychosocial aspects. Selective Cancer Therapeutics 1989;5(3):137-45. - PubMed
Mascardi 2015 {published data only}
    1. Mascardi V, Piroddi IMG, Grecchi B, Nicolini A. Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe COPD. European Respiratory Journal 2015;46(Suppl 59):3058. [DOI: 10.1183/13993003.congress-2015.PA3058] - DOI
Mather 1976 {published data only}
    1. Mather HG, Morgan DC, Pearson NG, Read KL, Shaw DB, Steed GR, et al. Myocardial infarction: a comparison between home and hospital care for patients. BMJ 1976;1(6015):925-9. - PMC - PubMed
Melin 1992 {published data only}
    1. Melin AL, Bygren LO. Efficacy of the rehabilitation of elderly primary health care patients after short-stay hospital treatment. Medical Care 1992;30(11):1004-15. - PubMed
Melin 1993 {published data only}
    1. Melin AL, Håkansson S, Bygren LO. The cost-effectiveness of rehabilitation in the home: a study of Swedish elderly. American Journal of Public Health 1993;83(3):356-62. - PMC - PubMed
Otero 2010 {published data only}
    1. Otero R, Uresandi F, Jiménez D, Cabezudo MA, Oribe M, Nauffal D, et al. Home treatment in pulmonary embolism. Thrombosis Research 2010;126(1):e1-5. [DOI: 10.1016/j.thromres.2009.09.026] - DOI - PubMed
Parsons 2018 {published data only}
    1. Parsons M, Parsons J, Rouse P, Pillai A, Mathieson S, Parsons R, et all. Supported Discharge Teams for older people in hospital acute care: a randomised controlled trial. Age and Ageing 2018;47(2):288-94. - PubMed
Rasmussen 2016 {published data only}
    1. Rasmussen RS, Østergaard A, Kjaer P, Skerris A, Skou C, Christoffersen J, et al. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: A randomised controlled trial. Clinical Rehabilitation 2016;30(3):225-36. [DOI: 10.1177/0269215515575165] - DOI - PubMed
Romano 1991 {published data only}
    1. Romano L, Minicucci L, Spallone E, Girosi D, Campelli A, Fabbri A, et al. [Role of home therapy with ofloxacin in patients with cystic fibrosis (CF)]. Giornale Italiano di Chemioterapia 1991;38:181-3. - PubMed
Rønning 1998 {published data only}
    1. Rønning OM, Guldvog B. Outcome of subacute stroke rehabilitation: a randomised controlled trial. Stroke 1998;29(4):779-84. - PubMed
Santana 2017 {published data only}
    1. Santana S, Rente, J, Neves C, Redondo P, Szczygiel N, Larsen T, et al. Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial. Clinical Rehabilitation 2017;31(2):197-206. - PMC - PubMed
Sigurdsson 2008 {published data only}
    1. Sigurdsson E, Siggeirsdottir K, Jonsson H Jr, Gudnason V, Matthiasson T, Jonsson BY. Early discharge and home intervention reduces unit costs after total hip replacement: Results of a cost analysis in a randomized study. International Journal of Health Care Finance & Economics 2008;8(3):181-192. [DOI: 10.1007/s10754-008-9036-0] - DOI - PubMed
Stone 1968 {published data only}
    1. Stone JR, Patterson E, Felson L. The effectiveness of home care for general hospital patients. JAMA 1968;205(3):145-8. - PubMed
Wade 1985 {published data only}
    1. Wade DT, Langton-Hewer R, Skilbeck CE, Bainton D, Burns-Cox C. Controlled trial of a home-care service for acute stroke patients. Lancet 1985;1(8424):323-6. - PubMed
Wang 2012 {published data only}
    1. Wang Y, Haugen T, Steihaug S, Werner A. Patients with acute exacerbation of chronic obstructive pulmonary disease feel safe when treated at home: A qualitative study. BMC Pulmonary Medicine 2012;12:45. [DOI: 10.1186/1471-2466-12-45] - DOI - PMC - PubMed
Williams 1981 {published data only}
    1. Williams PL, Crawley JC, Freeman AM, Lloyd DC, Gumpel JM. Feasibility of outpatient management after intra-articular yttrium-90: comparison of two regimens. BMJ (Clinical Research Edition) 1981;282(6257):13-4. - PMC - PubMed
Wolter 2004 {published data only}
    1. Wolter JM, Cagney RA, McCormack JG. A randomized trial of home vs hospital intravenous antibiotic therapy in adults with infectious diseases. Journal of Infection 2004;48(3):263-8. - PubMed
Zimmer 1984 {published data only}
    1. Zimmer JG, Groth-Juncker A, McCusker J. Effects of a physician-led home care team on terminal care. Journal of the American Geriatrics Society 1984;32(4):288-92. - PubMed
Zimmer 1985 {published data only}
    1. Zimmer JG, Groth-Juncker A, McCusker J. A randomized controlled study of a home health care team. American Journal of Public Health 1985;75(2):134-41. - PMC - PubMed

References to ongoing studies

ACTRN12611001243909 {published data only}
    1. ACTRN12611001243909. Establishing an effective and efficient Early Supported Discharge (ESD) rehabilitation program for Stroke clients in Perth WA. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347780 (first received 6 December 2011).
ISRCTN25318189 {published data only}
    1. ISRCTN25318189. Evaluation of Community Link Team - The effect of a community link team in facilitating early discharges from inpatient care. www.isrctn.com/ISRCTN25318189 (first received 23 January 2004).
NCT01622205 {published data only}
    1. NCT01622205. GOThenburg Very Early Supported Discharged (GOTVED). clinicaltrials.gov/ct2/show/NCT01622205 (first received 24th May 2012).
    1. Sunnerhagen KS, Danielsson A, Rafsten L, Björkdahl A, Axelsson ÅB, Nordin Å, et al. Gothenburg very early supported discharge study (GOTVED) NCT01622205: a block randomized trial with superiority design of very early supported discharge for patients with stroke. BMC Neurology 2013;13:66. [DOI: 10.1186/1471-2377-13-66] - DOI - PMC - PubMed

Additional references

Clarke 1984
    1. Clarke F. Hospital at home: The alternative to general hospital admission. London, Basingstoke: Macmillan Publishers Ltd, 1984.
Cochran 1954
    1. Cochran WG. The combination of estimates from different experiments. Biometrics 1954;10:101-29.
Crilly 2012
    1. Crilly J, Chaboyer W, Wallis M. A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. Journal of Advanced Nursing 2012;68(2):322-334. [DOI: 10.1111/j.1365-2648.2011.05740.x] - DOI - PubMed
Crotty 2000
    1. Crotty M, Kittel A, Hayball N. Home rehabilitation for older adults with fractured hips: how many will take part? Journal of Quality in Clinical Practice 2000;20(2-3):65-8. - PubMed
EPOC 2015a
    1. Effective Practice and Organisation of Care (EPOC). Data collection form. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services. Available at: epoc.cochrane.org/resources/epoc-resources-review-authors September 2015.
EPOC 2015b
    1. Effective Practice and Organisation of Care (EPOC). EPOC worksheets for preparing a Summary of Findings (SoF) table using GRADE. EPOC Resources for review authors.Oslo: Norwegian Knowledge Centre for the HealthServices. Available at: epoc.cochrane.org/resources/epoc-resources-review-authors September 2015.
EPOC 2015c
    1. Effective Practice and Organisation of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services. Available at: epoc.cochrane.org/resources/epoc-resources-review-authors September 2015.
Fearon 2012
    1. Fearon P, Langhorne P, Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No: CD000443. [DOI: 10.1002/14651858.CD000443] - DOI - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, the GRADE Working Group. What is "quality of evidence" and why is it important to clinicians? BMJ 2008;336(7651):995-8. - PMC - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analysis. BMJ 2003;327(7414):557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hughes 2000
    1. Hughes SL, Weaver FM, Giobbe-Hurder A, Manheim L, Henderson W, Kubal JD, et al, Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care. Effectiveness of team managed home based primary care: a randomized multicenter trial. JAMA 2000;284(22):2877-85. - PubMed
Hunt 2009
    1. Hunt GR, Hall GM, Murthy BV, O'Brien S, Beverland D, Lynch MC, et al. Early discharge following hip arthroplasty: Patients' acceptance masks doubts and concerns. Health Expectations 2009;12(2):130-7. [DOI: 10.1111/j.1369-7625.2008.00522.x] - DOI - PMC - PubMed
Iyengar 2007
    1. Iyengar KP, Nadkarni JB, Ivanovic N, Mahale A. Targeted early rehabilitation at home after total hip and knee joint replacement: Does it work? Disability and Rehabilitation 2007;29(6):495-502. - PubMed
Jeppesen 2012
    1. Jeppesen E, Brurberg KG, Vist GE, Wedzicha JA, Wright JJ, Greenstone M, et al. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No: CD003573. [DOI: 10.1002/14651858.CD003573.pub2] - DOI - PMC - PubMed
Lee 2015
    1. Lee G, Sakone P, Mulhall H, Kelleher K, Burnett K. Using hospital at home to reduce admissions. Nursing Times 2015;111(36-37):12-15. - PubMed
Leff 2005
    1. Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, et al. Hospital at home: feasibility and outcomes of a program to provide hospital level care at home for acutely ill older people. Annals of Internal Medicine 2005;143(11):798-808. - PubMed
Leff 2009
    1. Leff B, Burton L, Mader SL, Naughton B, Burl J, Greenough WB 3rd, et al. Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. Journal of the American Geriatrics Society 2009;57(2):273-8. [DOI: 10.1111/j.1532-5415.2008.02103.x] - DOI - PubMed
Lemelin 2007
    1. Lemelin J, Hogg WE, Dahrouge S, Armstrong CD, Martin CM, Zhang W, et al. Patient, informal caregiver and care provider acceptance of a hospital in the home program in Ontario, Canada. BMC Health Services Research 2007;7:130. - PMC - PubMed
Matthews 2007
    1. Matthews PC, Conlon CP, Berendt AR, Kayley J, Jeffries L, Atkins BL. Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self administer at home? A retrospective analysis of a large cohort over 13 years. Journal of Antimicrobial Chemotherapy 2007;60:356-62. - PubMed
McCurdy 2012
    1. McCurdy BR. Hospital-at-home programs for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Ontario Health Technology Assessment Series 2012;12(10):1-65. - PMC - PubMed
MECIR 2012
    1. Cochrane Editorial Unit. MECIR: Standards for the reporting of new Cochrane Intervention Reviews. community.cochrane.org/editorial-and-publishing-policy-resource/cochrane... (Accessed 29th May 2017).
Miller 2005
    1. Miller P, Gladman JRF, Cunliffe AL, Husbands SL, Dewey ME, Harwood RH. Economic analysis of an early discharge rehabilitation service for older people. Age and Ageing 2005;34(3):274-80. - PubMed
Morris 1983
    1. Morris DE. Santé Service Bayonne: a French approach to home care. Age and Ageing 1983;12(4):323-8. - PubMed
Parker 2002
    1. Parker G, Bhakta P, Lovett CA, Paisley S, Olsen R, Turner D, et al. A systematic review of the costs and effectiveness of different models of paediatric home care. Health Technology Assessment 2002;6:iii-108. - PubMed
Pound 1994
    1. Pound P, Gompertz P, Ebrahim S. Patients’ satisfaction with stroke services. Clinical Rehabilitation 1994;8:7-17.
Qaddoura 2015
    1. Qaddoura A, Yazdan-Ashoori P, Kabali C, Thabane L, Haynes RB, Connolly SJ, et al. Efficacy of hospital at home in patients with heart failure: a systematic review and meta-analysis. PLoS One 2015;10(6):e0129282. [DOI: 10.1371/journal.pone.0129282] - DOI - PMC - PubMed
Shepperd 2009a
    1. Shepperd S, Doll H, Gowers S, James T, Fazel M, Pollock A, FitzpatrickR, et al. Alternatives to inpatient mental health care for children and young people. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No: CD006410. [DOI: 10.1002/14651858.CD006410] - DOI - PMC - PubMed
Shepperd 2016a
    1. Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No: CD009231. [DOI: 10.1002/14651858.CD009231.pub2] - DOI - PMC - PubMed
Shepperd 2016b
    1. Shepperd S, Iliffe S, Doll HA, Clarke MJ, Kalra L, Wilson AD, et al. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No: CD007491. [DOI: 10.1002/14651858.CD007491.pub2] - DOI - PMC - PubMed
Vilà 2015
    1. Vilà A, Villegas E, Cruanyes J, Delgado R, Sabaté RA, Ortega J, et al, Program for the Care of Patients with Multimorbidity. Cost-effectiveness of a Barcelona home care program for individuals with multimorbidity. Journal of the American Geriatrics Society 2015;63(5):1017-24. [DOI: 10.1111/jgs.13396] - DOI - PubMed
WHO 2015
    1. World Health Organization. World Report on Ageing and Health. www.who.int/ageing/publications/world-report-2015/en/ 2015.

References to other published versions of this review

Shepperd 1996
    1. Shepperd S, Illife S. The effectiveness of hospital at home compared to in-patient hospital care. Cochrane Database of Systematic Reviews 1996, Issue 3. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356] - DOI
Shepperd 1998
    1. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database of Systematic Reviews 1998, Issue 1. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356] - DOI - PubMed
Shepperd 2001
    1. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356] - DOI - PubMed
Shepperd 2005
    1. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356.pub2] - DOI - PubMed
Shepperd 2009b
    1. Shepperd S, Doll H, Broad J, Gladman J, Iliffe S, Langhorne P, Richards S, Martin F, Harris R. Hospital at home early discharge. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356.pub3] - DOI - PMC - PubMed

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