Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data
Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data
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DOI：
10.1503/cmaj.081491
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发表时间：
2009-01-20
影响因子：
14.6
通讯作者：
Wilson, Andrew D.
中科院分区：
文献类型：
--
作者：
Shepperd, Sasha;Doll, Helen;Wilson, Andrew D.
背景：通过在家中提供医院护理来避免入院是一项计划，医疗保健专业人员在患者家中为患者提供积极治疗，否则需要在急症护理医院住院治疗。我们试图将这种护理患者的方法与此类住院护理的有效性进行比较。方法：我们检索了 MEDLINE、EMBASE、CINAHL 和 EconLit 数据库以及 Cochrane 有效实践和护理组织组登记册，从每个数据库最早的日期到 2008 年 1 月。我们纳入了随机对照试验，这些试验评估了一种替代急症护理医院入院的服务。我们排除了该计划无法替代住院护理的试验。我们对研究人群具有相似特征且测量了共同结果的试验进行了荟萃分析。结果：我们在系统评价中纳入了 10 项随机试验（总共 1327 名患者）。其中 7 项试验（总共 969 名患者）被认为有资格对个体患者数据进行荟萃分析，但我们只能获得其中 5 项试验的数据（总共 844 名患者 [87%]）。在家接受医院护理的患者 3 个月时的死亡率没有显着差异（调整后风险比 [HR] 0.77，95% 置信区间 [CI] 0.54-1.09，p=0.15）。然而，6 个月时，这些患者的死亡率显着降低（调整后 HR 0.62，95% CI 0.45-0.87，p=0.005）。在家接受医院护理的患者入院人数较多，但差异不显着（调整后 HR 1.49，95% CI 0.96-2.33，p=0.08）。在家接受医院护理的患者比接受住院护理的患者满意度更高。当分析仅限于实际接受的治疗并且排除非正式护理的费用时，这些计划比入住急症护理医院病房的费用要便宜。解释：对于选定的患者，通过在家中提供医院护理来避免入院，可以以相似或更低的成本获得与住院护理相似的结果。
Background: Avoidance of admission through provision of hospital care at home is a scheme whereby health care professionals provide active treatment in the patient's home for a condition that would otherwise require inpatient treatment in an acute care hospital. We sought to compare the effectiveness of this method of caring for patients with that type of in-hospital care.Methods: We searched the MEDLINE, EMBASE, CINAHL and EconLit databases and the Cochrane Effective Practice and Organisation of Care Group register from the earliest date in each database until January 2008. We included randomized controlled trials that evaluated a service providing an alternative to admission to an acute care hospital. We excluded trials in which the program did not offer a substitute for inpatient care. We performed meta-analyses for trials for which the study populations had similar characteristics and for which common outcomes had been measured.Results: We included 10 randomized trials (with a total of 1327 patients) in our systematic review. Seven of these trials (with a total of 969 patients) were deemed eligible for meta-analysis of individual patient data, but we were able to obtain data for only 5 of these trials (with a total of 844 patients [87%]). There was no significant difference in mortality at 3 months for patients who received hospital care at home (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.54-1.09, p=0.15). However, at 6 months, mortality was significantly lower for these patients (adjusted HR 0.62, 95% CI 0.45-0.87, p=0.005). Admissions to hospital were greater, but not significantly so, for patients receiving hospital care at home (adjusted HR 1.49, 95% CI 0.96-2.33, p=0.08). Patients receiving hospital care at home reported greater satisfaction than those receiving inpatient care. These programs were less expensive than admission to an acute care hospital ward when the analysis was restricted to treatment actually received and when the costs of informal care were excluded.Interpretation: For selected patients, avoiding admission through provision of hospital care at home yielded similar outcomes to inpatient care, at a similar or lower cost.