Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Mar 5;3(3):CD007491.
doi: 10.1002/14651858.CD007491.pub3.

Admission avoidance hospital at home

Kate Edgar  1 , Steve Iliffe  2 , Helen A Doll  3 , Mike J Clarke  4 , Daniela C Gonçalves-Bradley  5 , Eric Wong  6 , Sasha Shepperd  7
Affiliations
Meta-Analysis

Admission avoidance hospital at home

Kate Edgar et al. Cochrane Database Syst Rev. .

Abstract

Background: Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that would otherwise require acute hospital inpatient care, and always for a limited time period. This is the fourth update of this review.

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

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL on 24 February 2022, and checked the reference lists of eligible articles. We sought ongoing and unpublished studies by searching ClinicalTrials.gov and WHO ICTRP, and by contacting providers and researchers involved in the field.

Selection criteria: Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care.

Data collection and analysis: We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions, reported comparable outcomes with sufficient data, and used individual patient data when available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes.

Main results: We included 20 randomised controlled trials with a total of 3100 participants; four trials recruited participants with chronic obstructive pulmonary disease; two trials recruited participants recovering from a stroke; seven trials recruited participants with an acute medical condition who were mainly older; and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. For an older population, admission avoidance hospital at home probably makes little or no difference on mortality at six months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.68 to 1.13; P = 0.30; I2 = 0%; 5 trials, 1502 participants; moderate-certainty evidence); little or no difference on the likelihood of being readmitted to hospital after discharge from hospital at home or inpatient care within 3 to 12 months' follow-up (RR 1.14, 95% CI 0.97 to 1.34; P = 0.11; I2 = 41%; 8 trials, 1757 participants; moderate-certainty evidence); and probably reduces the likelihood of living in residential care at six months' follow-up (RR 0.53, 95% CI 0.41 to 0.69; P < 0.001; I2 = 67%; 4 trials, 1271 participants; moderate-certainty evidence). Hospital at home probably results in little to no difference in patient's self-reported health status (2006 patients; moderate-certainty evidence). Satisfaction with health care received may be improved with admission avoidance hospital at home (1812 participants; low-certainty evidence); few studies reported the effect on caregivers. Hospital at home reduced the initial average hospital length of stay (2036 participants; low-certainty evidence), which ranged from 4.1 to 18.5 days in the hospital group and 1.2 to 5.1 days in the hospital at home group. Hospital at home length of stay ranged from an average of 3 to 20.7 days (hospital at home group only). Admission avoidance hospital at home probably reduces costs to the health service compared with hospital admission (2148 participants; moderate-certainty evidence), though by a range of different amounts and using different methods to cost resource use, and there is some evidence that it decreases overall societal costs to six months' follow-up.

Authors' conclusions: Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of older people who have been referred for hospital admission. The intervention probably makes little or no difference to patient health outcomes; may improve satisfaction; probably reduces the likelihood of relocating to residential care; and probably decreases costs.

PubMed Disclaimer

Conflict of interest statement

KE: none known.

SI: none known.

HD: none known.

MC: is a Cochrane Editor, but was not involved in the editorial process of this review.

DGB: is a Cochrane Editor, but was not involved in the editorial process of this review.

EW: no declarations of interest.

SS is author of one of the included studies (Shepperd 2021); she did not perform risk of bias assessment, data extraction, or GRADE assessment for that study. SS is a Cochrane Editor, but was not involved in the editorial process of this review.

Figures

1
1
PRISMA 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: Admission avoidance hospital at home versus inpatient care, Outcome 1: Mortality at 3 months using IPD
1.2
1.2. Analysis
Comparison 1: Admission avoidance hospital at home versus inpatient care, Outcome 2: Mortality at 6 months' follow‐up (using published data, and IPD from Wilson and Shepperd)
1.3
1.3. Analysis
Comparison 1: Admission avoidance hospital at home versus inpatient care, Outcome 3: Readmission to hospital after discharge from hospital at home or inpatient care (3 to 12 months' follow‐up)
1.5
1.5. Analysis
Comparison 1: Admission avoidance hospital at home versus inpatient care, Outcome 5: Living in residential care at follow‐up
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Andrei 2011 {published data only}
    1. Andrei CL, Sinescu CJ, Ianula RM, Popa AI, Chioncel VP, Mischie AN, et al. Can be the home care of the heart failure patients a better economic alternative? European Journal of Heart Failure Supplements (Abstract) 2011;10(S1):S29.
Caplan 1999 {published data only}
    1. Board N, Brennan N, Caplan G. A randomised controlled trial of the costs of hospital as compared with hospital at home for acute medical patients. Australian and New Zealand Journal of Public Health 2000;24(3):305-11. [PMID: ] - PubMed
    1. Caplan GA, Coconis J, Woods J. Effect of hospital in the home treatment on physical and cognitive function: a randomized controlled trial. Journal of Gerontology 2005;60(8):1035-8. [PMID: ] - PubMed
    1. Caplan GA, Ward JA, Brennan NJ, Coconis J, Board N, Brown A. Hospital in the home: a randomised controlled trial. Medical Journal of Australia 1999;170(4):156-60. [PMID: ] - PubMed
Corwin 2005 {published data only}
    1. Corwin P, Toop L, McGeoch G, Than M, Wynn-Thomas S, Wells JE, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005;330(7483):129. [PMID: ] - PMC - PubMed
Davies 2000 {published and unpublished data}
    1. Davies L, Wilkinson M, Bonner S, Calverley PM, Angus RM. Hospital at home versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial. BMJ 2000;321(7271):1265-8. [PMID: ] - PMC - PubMed
Echevarria 2018 {published data only}
    1. Dismore LL, Echevarria C, Wersch A, Gibson J, Bourke S. What are the positive drivers and potential barriers to implementation of hospital at home selected by low-riskDECAF score in the UK: a qualitative study embedded within a randomised controlled trial. BMJ Open 2019;9:e026609. [DOI: 10.1136/bmjopen-2018-026609] - DOI - PMC - PubMed
    1. Echevarria C, Gray J, Hartley T, Steer J, Miller J, Simpson AJ, et al. Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlledtrial and economic evaluation. Thorax 2018;73:713-22. [DOI: 10.1136/thoraxjnl-2017-211197] - DOI - PMC - 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 randomised controlled trial. Journal of Health Services and Research Policy 2005;10(3):158-66. [PMID: ] - PubMed
Kalra 2000 {published data only}
    1. Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet 2000;356(9233):894-9. [PMID: ] - PubMed
    1. Patel A, Knapp M, Perez I, Evans A, Kalra L. Alternative strategies for stroke care: cost effectiveness and cost-utility analyses from a prospective randomized controlled trial. Stroke 2004;35(1):196-203. [PMID: ] - PubMed
Levine 2018 {published data only}
    1. Levine DM, Ouchi K, Blanchfield B, Diamond K, Licurse A, Pu CT, et al. Hospital-level care at home for acutely ill adults: a pilot randomized controlled trial. Journal of General Internal Medicine 2018;33(5):729-36. [DOI: 10.1007/s11606-018-4307-z] - DOI - PMC - PubMed
Levine 2020 {published data only}
    1. Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, et al. Hospital-level care at home for acutely ill adults: a randomized controlled trial. Annals of Internal Medicine 2020;172(2):77-92. [DOI: 10.7326/M19-0600] - DOI - PubMed
    1. Levine DM, Pian J, Mahendrakumar K, Patel A, Saenz A, Schnipper JL. Hospital-level care at home for acutely ill adults: a qualitative evaluation of a randomized controlled trial. Journal of General Internal Medicine 2021;36(7):1965-73. [DOI: 10.1007/s11606-020-06416-7] - DOI - PMC - PubMed
Mendoza 2009 {published and unpublished data}
    1. Mendoza H, Martin MJ, Garcia A, Aros F, Aizpuru F, Regalado de Los Cobos J, et al. Hospital at home care model as an effective alternative in the management of decompensated chronic heart failure. European Journal of Heart Failure 2009;11:1208-13. - PubMed
Nicholson 2001 {published data only}
    1. Nicholson C, Bowler S, Jackson C, Schollay D, Tweeddale M, O'Rourke P. Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease. Australian Health Review 2001;24(4):181-7. [PMID: ] - PubMed
Ricauda 2004 {published data only}
    1. Ricauda NA, Bo M, Molaschi M, Massaia M, Salerno K, Amati D, et al. Home hospitalization service for acute uncomplicated first ischemic stroke in elderly patients: a randomized trial. Journal of the American Geriatrics Society 2004;52(2):278-83. [PMID: ] - PubMed
    1. Ricauda NA, Pla LF, Marinello M, Molaschi M, Fabris F. Feasibility of an acute stroke home care service for elderly patients. Archives of Gerontology and Geriatrics 1998;26(Suppl 6):17-22. [EMBASE: 1998333220]
Ricauda 2008 {published data only}
    1. Ricauda NA, Tibaldi V, Leff B, Scarafiotti C, Marinello R, Zanocchi M, et al. Substitutive hospital at home versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Journal of the American Geriatrics Society 2008;56:493-500. - PubMed
Richards 2005 {published data only}
    1. Richards DA, Toop LJ, Epton MJ, McGeoch RB, Town GI, Wynn-Thomas SM, et al. Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial. Medical Journal of Australia 2005;183(5):235-8. [PMID: ] - PubMed
Shepperd 2021 {published and unpublished data}
    1. Mäkelä P, Godfrey M, Cradduck-Bamford C, Ellis G, Shepperd S. A protocol for the process evaluation of a multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials 2018;19:569. [DOI: 10.1186/s13063-018-2929-4] - DOI - PMC - PubMed
    1. Shepperd S, Butler C, Cradduck-Bamford A, Ellis G, Gray A, Hemsley A, et al. Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons?: a randomized trial. Annals of Internal Medicine 2021;174(7):889-98. [DOI: 10.7326/M20-5688] - DOI - PMC - PubMed
    1. Shepperd S, Cradduck-Bamford A, Butler C, Ellis G, Goddfrey M, Gray A, et al. A multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials 201;18:491. [DOI: 10.1186/s13063-017-2214-y] - DOI - PMC - PubMed
    1. Singh S, Gray A, Shepperd S, Stott DJ, Ellis G, Hemsley A, et al. Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people? Age and Ageing 2022;51(1):afab220. [DOI: 10.1093/ageing/afab220] - DOI - PMC - PubMed
Talcott 2011 {published data only}
    1. Hendricks AM, Loggers ET, Talcott JA. Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial. Journal of Clinical Oncology 2011;29:3984-9. - PMC - PubMed
    1. Talcott JA, Yeap JA, Siegal RD, Loggers ET, Lu C, Godley PA. Safety of early discharge for low risk patients with febrile neutropenia: A multicentre randomised controlled trial. Journal of Clinical Oncology 2011;29:3977-83. - PMC - PubMed
Tibaldi 2004 {published data only}
    1. Tibaldi V, Aimonino N, Ponzetto M, Stasi MF, Amati D, Raspo S, et al. A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress. Archives of Gerontology and Geriatrics - Supplement 2004;38(9):431-6. [PMID: ] - PubMed
Tibaldi 2009 {published data only}
    1. Tibaldi V, Isaia G, Scarafiotti C, Gariglio F, Zanocchi M, Bo M, et al. Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial. Archives of Internal Medicine 2009;169:1569-75. - PubMed
Vianello 2013 {published data only}
    1. Vianello A, Savoia F, Pipitone E, Nordio B, Gallina G, Paladini L, et al. “Hospital at home” for neuromuscular disease patients with respiratory tract infection: a pilot study. Respiratory Care 2013;12(58):2061-8. - PubMed
Wilson 1999 {published and unpublished data}
    1. Jones J, Wilson A, Parker H, Wynn A, Jagger C, Spiers N, et al. Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial. BMJ 1999;319(7224):1547-50. [PMID: ] - PMC - PubMed
    1. Wilson A, Parker H, Wynn A, Jagger C, Spiers N, Jones J, et al. Randomised controlled trial of effectiveness of Leicester hospital at home scheme compared with hospital care. BMJ 1999;319(7224):1542-6. [PMID: ] - PMC - PubMed
    1. Wilson A, Wynn A, Parker H. Patient and carer satisfaction with 'hospital at home': quantitative and qualitative results from a randomised controlled trial. British Journal of General Practice 2002;52(474):9-13. [PMID: ] - PMC - PubMed

References to studies excluded from this review

Cabrol 2000 {published data only}
    1. Cabrol J, Güell M, Brullet E, Campo R, Calvet X, Laporte E. Home versus hospital treatment of patients with uncomplicated upper gastrointestinal bleeding. Prospective randomized study [Tratamiento domicilario versus ingreso hospitalario de los pacientes con hemorragia digestiva alta no complicada: Estudio prospectivo y randomizado]. Revista Española of Enfermedades Digestivas 2000;92(Suppl. 1):31.
Duiverman 2019 {published data only}
    1. Duiverman ML, Vonk JM, Bladder G, Van Melle JP, Nieuwenhuis J, Hazenberg A, et al. Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2019;75:244-52. - PMC - PubMed
Hazenberg 2014 {published data only}
    1. Hazenberg A, Kerstjens HA, Prins SC, Vermeulen KM, Wijkstra PJ. Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs. Respiratory Medicine 2014;108(9):1387-95. - 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
King 2000 {published data only}
    1. King MT, Hall J, Caleo S, Gurney HP, Harnett PR. Home or hospital? An evaluation of the costs, preferences and outcomes of domiciliary chemotherapy. International Journal of Health Services 2000;30:557-79. - PubMed
Levine 2021 {published data only}
    1. Levine DM, Schnipper JL. Remote physician care for home hospital patients: a randomized controlled noninferiority trial. Journal of General Internal Medicine 2021;36:S48. - PMC - PubMed
Mascardi 2016 {published data only}
    1. Mascardi V, Grecchi B, Barlascini C, Banfi P, Nicolini A. Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe chronic obstructive pulmonary disease. Journal of Thoracic Disease 2016;8(10):2895-902. - PMC - PubMed
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
NCT02363413 {published data only}
    1. NCT02363413. Initiation of non-invasive ventilation at home versus hospital among patients with overlap syndrome (OVNI-Dom). clinicaltrials.gov/ct2/show/NCT02363413 (first received 16 February 2015).
NCT03490084 {published data only}
    1. NCT03490084. Impacts on health outcomes and resources utilization of hospital-at-home for elderly patients with multiple myeloma (PAMM-HAD1). clinicaltrials.gov/ct2/show/NCT03490084 (first received 27 February 2020).
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. [PMID: ] - PubMed
Wolfe 2000 {published data only}
    1. Wolfe CDA, Tilling K, Rudd AG. The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial. Clinical Rehabilitation 2000;14(6):563-9. [PMID: ] - PubMed

References to ongoing studies

NCT03156686 {published data only}
    1. NCT03156686. SAFEty and Efficacy of HOME-based hospitalization versus inpatient care for patients with acute heart failure in chronic heart failure. (SAFE-HOME). clinicaltrials.gov/ct2/show/NCT03156686 (first received 17 May 2017).
Pouw 2018 {published data only}
    1. Pouw MA, Calf AH, Munster BC, Ter Maaten JC, Smidt N, Rooij SE. Hospital at Home care for older patients with cognitive impairment: a protocol for a randomised controlled feasibility trial. BMJ Open 2018;8(3):e020332. - PMC - PubMed

Additional references

Arsenault‐Lapierre 2021
    1. Arsenault-Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta-analysis. JAMA Network Open 2021;4(6):e2111568. [DOI: 10.1001/jamanetworkopen.2021.11568] - DOI - PMC - PubMed
Aviv 2021
    1. Aviv R. Intensive home care for COVID-19 to reduce admissions. Home Health Care Management & Practice 2021;33(4):320-2. - PMC - PubMed
Batt 2023
    1. Batt R, Appelbaum E. The new hospital at home movement: opportunity or threat for patient care? Public Policy & Aging Report 2023;33(2):63-9. [DOI: 10.1093/ppar/prad004] - DOI
Board 2000
    1. Board N, Brennan N, Caplan G. A randomised controlled trial of the costs of hospital as compared with hospital at home for acute medical patients. Australian and New Zealand Journal of Public Health 2000;24(3):305-11. [PMID: ] - PubMed
British Geriatrics Society 2022
    1. British Geriatrics Society. Bringing hospital care home: Virtual Wards and Hospital at Home for older people; August 2022. www.bgs.org.uk/virtualwards (accessed prior to 3 November 2023).
Bumrungrad 2023
    1. Bumrungrad International Hospital. Bumrungrad @ Home Service Center. www.bumrungrad.com/en/centers/home-service-center (accessed prior to 23 August 2023).
Chong 2022
    1. Chong C. Some patients can now be hospitalised at home and be cared for via teleconsultations, home visits; October 2022. www.straitstimes.com/singapore/some-patients-can-now-be-hospitalised-at-... (accessed prior to 3 November 2023).
CNN Philippines 2021
    1. CNN Philippines. Healthcare firm offers home services for patients; April 2021. www.cnnphilippines.com/news/2021/4/23/Healthcare-firm-offers-home-servic....
Cochran 1954
    1. Cochran WG. The combination of estimates from different experiments. Biometrics 1954;10:101-29. [PsycINFO: 1955-00087-001]
Covinsky 2003
    1. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic DM, et al. Loss of independence in activities of daily living in older adults hospitalised with medical illness: increased vulnerability with age. Journal of the American Geriatrics Society 2003;51:51-8. - PubMed
de Sousa Vale 2020
    1. Sousa Vale J, Franco AI, Oliveira CV, Araújo I, Sousa D. Hospital at home: an overview of literature. Home Health Care Management & Practice 2020;32(2):118-23.
Deeks 2001
    1. Deeks JJ, Altman D, Bradburn MJ. Chapter 15. Statistical methods for examining heterogeneity and combining results from several studies in meta‐analysis. In: Egger M, Davey Smith G, Altman DG, editors(s). Systematic Reviews in Health Care: Meta‐Analysis in Context. 2nd edition. Wiley, 2001:285-312. [DOI: 10.1002/9780470693926.ch15] - DOI
Ellis 2017
    1. Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No: CD006211. [DOI: 10.1002/14651858.CD006211.pub3] - DOI - PMC - PubMed
EndNote [Computer program]
    1. EndNote 20. Philadelphia, PA: Clarivate, 2013.
EPOC 2015a
    1. Effective Practice and Organisation of Care (EPOC). Oslo: Norwegian Knowledge Centre for the Health Services. Data collection form. EPOC Resources for review authors. epoc.cochrane.org/epoc-specific-resources-review-authors (accessed September 2015).
EPOC 2015b
    1. Effective Practice and Organisation of Care (EPOC). Oslo: Norwegian Knowledge Centre for the Health Services. Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors. epoc.cochrane.org/epoc-specific-resources-review-authors (accessed September 2015).
EPOC 2017
    1. Effective Practice and Organisation of Care (EPOC). Oslo: Norwegian Knowledge Centre for the Health Services. EPOC worksheets for preparing a Summary of Findings (SoF) table using GRADE. EPOC Resources for review authors. epoc.cochrane.org/epoc-specific-resources-review-authors (accessed July 2022).
Gonçalves‐Bradley 2017
    1. Gonçalves-Bradley DC, Iliffe S, Doll HA, Broad J, Gladman J, Langhorne P, et al. Early discharge hospital at home. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356.pub4] - DOI - PMC - PubMed
GRADEpro GDT 2022 [Computer program]
    1. GRADEpro GDT. Version accessed 29 December 2023. Hamilton (ON): McMaster University (developed by Evidence Prime), 2022. Available at gradepro.org.
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;336:995-8. - PMC - PubMed
Hernandez 2003
    1. Hernandez C, Casas A, Escarrabill J, Alonso J, Puig-Junoy J, Farrero E, et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. European Respiratory Journal 2003;21(1):58-67. [DOI: 10.1183/09031936.03.00015603] - DOI - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [PMID: ] - PMC - PubMed
Higgins 2019
    1. Higgins JPT, Thomas J, Chandler J, Compston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions. 2nd edition. Chichester (UK): John Wiley & Sons, 2019.
Jeppesen 2012
    1. Jeppesen E, Bruberg 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
Jones 1999
    1. Jones J, Wilson A, Parker H, Wynn A, Jagger C, Spiers N, et al. Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial. BMJ 1999;319(7224):1547-50. [PMID: ] - PMC - PubMed
Karacaoglu 2021
    1. Karacaoglu K. Staff views of a hospital at home model implemented in a Scottish care setting. AIMS Public Health 2021;8(3):467. - PMC - PubMed
Kimmel 2020
    1. Kimmel LA, Burge A, Watterson D, Wolters C, Holland A, Reed M, et al. Substituting inpatient rehabilitation beds for home‐based multidisciplinary rehabilitation: a qualitative study of patient perceptions. Australasian Journal on Ageing 2021;40(3):275-82. [DOI: 10.1111/ajag.12883] - DOI - PubMed
Kumpf 2019
    1. Kumpf VJ. Challenges and obstacles of long-term home parenteral nutrition. Nutrition in Clinical Practice 2019;34(2):196-203. [DOI: 10.1002/ncp.10258] - DOI - PubMed
Langhorne 2020
    1. Langhorne P, Ramachandra S. Organised inpatient (stroke unit) care for stroke: network meta‐analysis. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No: CD000197. [DOI: 10.1002/14651858.CD000197.pub4] - DOI - PMC - PubMed
Langhorne 2021
    1. Langhorne P. The Stroke Unit Story: where have we been and where are we going? Cerebrovascular Diseases 2021;50(6):636-43. [DOI: 10.1159/000518934] - DOI - PubMed
Leary 2022
    1. Leary A. Saved bed days: the ultimate currency. BMJ 2022;378:o1686. [DOI: 10.1136/bmj.o1686] - DOI - PubMed
Lefebvre 2021
    1. Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M-I, et al. Technical Supplement to Chapter 4: Searching for and selecting studies. In: Higgins JP, Thomas J, Chandler J, Cumpston MS, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook/archive/v6.2.
Leff 2006
    1. Leff B, Burton L, Mader S, Naughton B, Burl J, Clark R, et al. Satisfaction with hospital at home care. Journal of the American Geriatrics Society 2006;54(9):1355-63. [DOI: 10.1111/j.1532-5415.2006.00855.x] - DOI - PubMed
Leff 2009
    1. Leff B. Defining and disseminating the hospital-at-home model. CMAJ: Canadian Medical Association Journal 2009;180(2):156-7. - PMC - PubMed
Leff 2022
    1. Leff B, DeCherrie LV, Montalto M, Levine DM. A research agenda for hospital at home. Journal of the American Geriatrics Society 2022;70(4):1060-9. [DOI: 10.1111/jgs.17715] - DOI - PMC - PubMed
Leong 2021
    1. Leong MQ, Lim CW, Lai YF. Comparison of Hospital-at-Home models: a systematic review of reviews. BMJ Open 2021;11(1):e043285. [DOI: 10.1136/bmjopen-2020-043285] - DOI - PMC - PubMed
Levine 2021
    1. Levine DM, Pian J, Mahendrakumar K, Patel A, Saenz A, Schnipper JL. Hospital-level care at home for acutely ill adults: a qualitative evaluation of a randomized controlled trial. Journal of General Internal Medicine 2021;36(7):1965-73. [DOI: 10.1007/s11606-020-06416-7] - DOI - PMC - PubMed
Loyd 2020
    1. Loyd C, Larkland AD, Zhang Y, Fowler M, Harper S, Wright NC, et al. Prevalence of hospital-associated disability in older adults: a meta-analysis. Journal of the American Medical Directors Association 2020;21(4):455-461.e5. [DOI: 10.1016/j.jamda.2019.09.015] - DOI - PMC - PubMed
Mackay 2023
    1. Mackay I, France M, McAuley D, Wing S, Wheeldon M, Britton S, et al. COVID‐19 (Omicron strain) hospital admissions from a virtual ward – who required further care? Influenza and Other Respiratory Viruses 2023;17(3):e13108. [DOI: 10.1111/irv.13108] - DOI - PMC - PubMed
Makela 2020
    1. Mäkelä P, Stott D, Godfrey M, Ellis G, Schiff R, Shepperd S. The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting. Age and Ageing 2020;49(5):856-64. [DOI: 10.1093/ageing/afaa085] - DOI - PMC - PubMed
MECIR 2012
    1. Standards for the reporting of new Cochrane Intervention Reviews. web.archive.org/web/20230328142021/https://community.cochrane.org/mecir-... (accessed 19 February 2016).
Mernin 2021
    1. Mernin A. 'Hospital at home’ technology to expand care capacity in India; November 2021. www.htworld.co.uk/news/hospital-at-home-india/#:~:text=The%20'hospi... (accessed prior to 3 November 2023).
Monitor 2015
    1. Monitor: Making the health sector work for patients. Moving healthcare closer to home: Literature review of clinical impacts. www.gov.uk/government/uploads/system/uploads/attachment_data/file/459268... (accesed 17 August 2015).
Montalto 2020
    1. Montalto M, McElduff P, Hardy K. Home ward bound: features of hospital in the home use by major Australian hospitals, 2011–2017. Medical Journal of Australia 2020;213(1):22-7. [DOI: 10.5694/mja2.50599] - DOI - PubMed
Mudge 2019
    1. Mudge AM, McRae P, Hubbard RE, Peel NM, Lim WK, Barnett AG, et al. Hospital‐associated complications of older people: a proposed multicomponent outcome for acute care. Journal of the American Geriatrics Society 2019;67(2):352-6. - PMC - PubMed
Naik 2006
    1. Naik G. Portland hospital gives acutely ill a homecare option; 19 April 2006. www.wsj.com/articles/SB114540442717929396 (accessed prior to 3 November 2023).
NCT04330378
    1. NCT04330378. A hospital-at-home pilot in Singapore: a prospective quasi-experimental cohort study. clinicaltrials.gov/study/NCT04330378 (first received 31 March 2020).
NHS Digital 2019
    1. NHS Digital. Hospital admitted patient care and adult critical care activity. digital.nhs.uk/data-and-information/publications/statistical/hospital-ad... (accessed 22 February 2021).
NHS England 2021
    1. NHS England. Guidance note: Frailty virtual ward (Hospital at Home for those living with frailty); December 2021. www.england.nhs.uk/publication/guidance-note-frailty-virtual-ward-hospit... (accessed prior to 3 November 2023).
NICE 2019
    1. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management NICE guideline NG128; May 2019. www.nice.org.uk/guidance/ng128/chapter/recommendations#specialist-care-f... (accessed prior to 3 November 2023).
Nogues 2021
    1. Nogués X, Sánchez-Martinez F, Castells X, Díez-Pérez A, Sabaté RA, Petit I, et al. Hospital-at-Home expands hospital capacity during COVID-19 pandemic. Journal of the American Medical Directors Association 2021;22(5):939-42. - PMC - PubMed
Nolte 2008
    1. Nolte E, McKee M. Caring for People With Chronic Conditions: A Health System Perspective. Maidenhead: McGraw Hill Open University Press, 2008.
Nundy 2020
    1. Nundy S, Patel KK. Hospital-at-home to support COVID-19 surge – time to bring down the walls? JAMA Health Forum 2020;1(5):e200504. [DOI: 10.1001/jamahealthforum.2020.0504] - DOI - PubMed
Oliver 2021
    1. Oliver D. David Oliver: the pandemic has delivered clinical service innovations worth keeping. BMJ 2021;373:n1306. [DOI: 10.1136/bmj.n1306] - DOI - PubMed
Patel 2004
    1. Patel A, Knapp M, Perez I, Evans A, Kalra L. Alternative strategies for stroke care: cost effectiveness and cost utility analysis from a prospective randomised controlled trial. Stroke 2004;35(1):196-203. [PMID: ] - PubMed
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
Queensland Government 2022
    1. Queensland Government. Hospital in the home. www.health.qld.gov.au/system-governance/policies-standards/guidelines/ho... (accessed prior to 3 November 2023).
Rafter 2015
    1. Rafter N, Hickey A, Condell S, Conroy R, O'Connor P, Vaughan D, et al. Adverse events in healthcare: learning from mistakes. QJM 2015;108(4):273-7. - PubMed
RCP 2017
    1. Royal College of Physicians. Delivering the future hospital: full report. www.rcplondon.ac.uk/projects/outputs/future-hospital-programme-deliverin... (accessed 22 February 2021).
Review Manager 2020 [Computer program]
    1. Review Manager (RevMan). Version 5.4. Copenhagen: The Cochrane Collaboration, 2020.
Shepperd 2016b
    1. Shepperd S, Gonçalves-Bradley DC, Wee B, Straus SE. Hospital at home: home-based end of life care. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No: CD009231. [DOI: 10.1002/14651858.CD009231.pub3] - DOI - PMC - PubMed
Simon 2022
    1. Simon DA, Cohen IG, Balatbat C, Offodile AC 2nd. The hospital-at-home presents novel liabilities for physicians, hospitals, caregivers, and patients. Nature Medicine 2022;28(3):438-41. [DOI: 10.1038/s41591-022-01697-3] - DOI - PubMed
Singh 2022
    1. Singh S, Gray A, Shepperd S, Stott DJ, Ellis G, Hemsley A, et al. Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people? Age and Ageing 2022;51(1):afab220. [DOI: 10.1093/ageing/afab220] - DOI - PMC - PubMed
Stata 16.1 [Computer program]
    1. Stata Statistical Software: Release 16.. StataCorp. College Station, TX: StataCorp LLC., 2019.
Steventon 2018
    1. Steventon A, Deeny S, Friebel R, Gardner T, Thorlby R. Emergency hospital admissions in England: Which may be avoidable and how? www.health.org.uk/publications/emergency-hospital-admissions-in-england-... (accessed 22 February 2021).
Thornton 2020
    1. Thornton J. The 'virtual wards' supporting patients with covid-19 in the community. BMJ 2020;369:m2119. [DOI: 10.1136/bmj.m2119] - DOI - PubMed
Vindrola‐Padros 2021
    1. Vindrola-Padros C, Singh KE, Sidhu MS, Georghiou T, Sherlaw-Johnson C, Tomini SM, et al. Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review. EClinicalMedicine 2021;37:100965. [DOI: 10.1016/j.eclinm.2021.100965] - DOI - PMC - PubMed
Virtual Wards 2022
    1. NHS England. Bringing hospital care home: Virtual Wards and Hospital at Home for older people. www.england.nhs.uk/virtual-wards/ (accessed 2 December 2022).
Vlachantoni 2012
    1. Vlachantoni A. Financial inequality and gender in older people. Maturitas 2012;72(2):104-7. [DOI: 10.1016/j.maturitas.2012.02.015] - DOI - PubMed
Wallis 2024
    1. Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, et al. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No: CD014765. [DOI: 10.1002/14651858.CD014765.pub2] - DOI - PMC - PubMed
WHO 2021 to 2030
    1. World Health Organization. WHO's work on the UN Decade of Healthy Ageing (2021-2030). www.who.int/initiatives/decade-of-healthy-ageing (accessed 3 May 2023).
Young 2005
    1. Young H, Grundy E, Kalogirou S. Who cares? Geographic variation in unpaid caregiving in England and Wales: evidence from the 2001 census. Population Trends 2005;120:23-34. - PubMed

References to other published versions of this review

Shepperd 1998
    1. Shepperd S, Iliffe S. Effectiveness of hospital at home compared to in-patient hospital care. Cochrane Database of Systematic Reviews 1998, Issue 1. Art. No: CD000356. [DOI: 10.1002/14651858.CD000356] - DOI
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] [PMID: ] - DOI - PubMed
Shepperd 2008
    1. Shepperd S, Doll H, Angus RM, Clarke MJ, Illife S, Kalra L, et al. Hospital at home admission avoidance. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD007491. [DOI: 10.1002/14651858.CD007491] - DOI - PMC - PubMed
Shepperd 2016a
    1. Shepperd S, Iliffe S, Doll HA, Clarke MJ, Karla 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