Although hospitalisation is associated with mortality, adverse events and deteriorating cognitive and physical function, one cannot assume that a change of location will alter such outcomes. HITH has increased in popularity because of concerns about safety, availability and cost of inhospital care. 71 The literature is confusing because many studies on HITH do not use the term HITH (or any similar terms) and some studies use the term HITH but do not involve substitution for inhospital care. 9, 10 Some focus on specialties (eg, surgical specialties, 11 - 20 medical specialties, 21 - 33 rehabilitation medicine, 34, 35 geriatrics, 36, 37 psychiatry, 38 - 42 infectious diseases, 43, 44 respiratory diseases 45 - 55 or orthopaedics 56), diagnostic groups (eg, hip fracture 57, 58 or stroke 59 - 70) or a mixture. Most HITH services are nurse based, but they may include doctors and allied health professionals.
META DEFINITION MEDICAL FULL
HITH includes admission avoidance (ie, full substitution for hospitalisation) and early discharge followed by care at home (ie, shortened hospitalisation). The key is substituting for inhospital care. 1 It is also known as “hospital at home”, “home hospitalisation” and “early supported discharge”, 2 - 6 and it has been speculated that HITH improves outcomes.
“Hospital in the home” (HITH) provides acute or subacute treatment in a patient’s residence for a condition that would normally require admission to hospital. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00 95% CI, − 0.19 to 0.19).Ĭonclusion: HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. The number needed to treat at home to prevent one death was 50. Study selection: Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years.ĭata extraction: Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist.ĭata synthesis: 61 RCTs met the inclusion criteria. Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.ĭata sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012. Statistics, epidemiology and research design.
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