SRF030: Hospital-at-Home interventions for persons with chronic illness presenting at the emergency department: A systematic review

Mary Henein; Geneviève Arsenault-Lapierre, PhD; Dina Gaid, MSc, PhD candidate; Genevieve Gore, MLIS; Melanie Le Berre, MSc; Isabelle Vedel, MD, PhD


Context: Hospitalizations are costly and risky, especially for vulnerable patients with chronic illness. Several systematic reviews have looked at Hospital-at-Home (HaH) interventions and suggest that it may reduce the risks associated with hospitalization and improve patient outcomes. However, results for patient outcomes remain inconsistent according to a recent meta-review, which looked at HaH reviews of various populations. Objective: To assess the effectiveness of HaH when considering patient outcomes for persons with all types of chronic illnesses who present to the emergency department. Design: Systematic review with meta-analysis and narrative analysis. Setting: The following databases were searched: OVID MEDLINE, OVID EMBASE, OVID PsycINFO, CINAHL (EBSCOhost), HTA (Centre for Reviews and Dissemination), Cochrane Reviews and CENTRAL Trials (Cochrane Library), OVID Allied and Complementary Medicine Database (AMED), WHO International Clinical Trials Registry Platform (ICTRP), and Main and Secondary Outcome Measures: Pooled risk ratio and mean difference for mortality, subsequent hospital admissions, and length of treatment. Descriptive analysis for outcomes that are either only reported by one study or measured in two or more studies using different tools, for which we cannot find evidence of comparability. Results: Preliminary results show that mortality does not differ between HaH and in-hospital care (RR 0.84, 95%CI 0.61, 1.16) and subsequent hospital admissions is slightly lower with HaH (RR 0.73, 95%CI 0.57, 0.94). Conclusions: HaH shows potential to improve patient outcomes and be equally as safe as in-hospital care for persons with all types of chronic illnesses presenting to the emergency department.
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Jack 11/21/2020

great project. HaH is new to me, so thanks for the education. and thanks for sharing this with NAPCRG

Tyler Barreto

Great work! I have two questions: 1) I have seen data on decreased cost with HaH. Here you note that there is an increase in stay of about 5 days -- does this increase in stay impact the cost benefits? 2) With your findings showing benefits to patients and families, why do you think HaH isn't more widely implemented?

Isabelle Vedel

Great questions Tyler. We did not look at cost as the evidence is quite clear about a decrease of cost with HaH. We looked at outcomes where evidence is contradicting. It will be a nice study to look at barriers of implementing HaH. I would guess that home visits by physicians, inappropriate financial compensation mechanisms, hospitals wanting to maintain the same number of hospital beds... might be some barriers. What do you think ?

Judy Belle Brown

Great work and did you come across the HaH work Moira Stewart et al. did several years ago ?

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