The rate of admissions in elderly patients to acute hospital care in the United Kingdom has increased by 65 percent in the last decade, placing increased labor and cost demands on hospital systems. While hospitalization is often appropriate and required, vague admission guidelines in a variety of lung conditions occasionally result in older individuals who do not require acute hospitalization to be admitted.
A recent review study identified that “hospital at home” represents a beneficial alternative to acute hospitalization for some patients.
The study, “Evidence report: alternative to acute hospital care for people over 65 years of age being considered for potentially avoidable admission,” was funded by the National Institute for Health Research.
Researchers compiled data from many research studies published in the last 15 years to determine the effectiveness of alternatives to hospitalization of elderly people (those over 65 years old), whose admission was considered to be potentially avoidable.
Five alternatives to acute hospitalization were assessed, including paramedic intervention, alternative hospital care, community hospitals, hospital at home (HaH), and nursing home care. The effectiveness of these alternatives for treatment of several lung diseases, including chronic obstructive pulmonary disease (COPD), pulmonary embolism, and pneumonia, were assessed.
Hospital-type services that are administered in a patient’s own home is termed HaH. For some conditions that normally require acute hospitalization, some have suggested that acute and subacute treatment can be effectively and safely administered at home.
By analyzing and compiling data from 19 primary studies, the research team found that this alternative was the most effective and well-studied alternative to hospitalization.
Importantly, hospital at home is comparable, and more satisfactory in some cases, than acute care. COPD patients, specifically, who used HaH as an alternative to acute hospitalization exhibited a reduction in readmission, decreased mortality rates, increased safety, and comparable patient and caregiver satisfaction.
While less information is available for the effectiveness of HaH on those suffering from pulmonary embolism and pneumonia, the authors determined that HaH is a comparable alternative to acute hospitalization for both lung conditions.
Overall, the evaluation of numerous studies support HaH as a comparable, and in some cases more beneficial, alternative to acute hospitalization for lung conditions such as COPD.
More studies are required to expand the range of lung diseases that are suitable for hospital at home. The authors also recommend that future studies focus specifically on the cost-effectiveness of HaH and qualitative assessments of patient and caregiver responses.
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