Authors' objectives: The objective of this analysis was to compare hospital-at-home care with inpatient hospital care for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) who present to the emergency department (ED).

Authors' recommendations: The following conclusions are based on low to very low quality of evidence. The reviewed evidence was based on RCTs that were inadequately powered to observe differences between hospital-at-home and inpatient hospital care for most outcomes, so there is a strong possibility that type II error is an issue. Given the low to very low quality of evidence, these conclusions must be considered with caution. - Approximately 21% to 37% of patients with acute exacerbations of COPD who present to the ED may be eligible for hospital-at-home care. - Of the patients who are eligible for care, some patients may refuse to participate in hospital-athome care. - Eligibility for hospital-at-home care may be increased depending on the design of the hospital-athome program such as the size of the geographical service area for hospital-at-home and the hours of operation for patient assessment and entry into hospital-at-home. - Hospital-at-home care for acute exacerbations of COPD was associated with a nonsignificant reduction in the risk of mortality and hospital readmissions compared with inpatient hospital care during 2- to 6-months follow-up. - Limited, very low quality evidence suggests that hospital readmissions are delayed after hospital at-home care compared with inpatient hospital care (mean additional days before readmission comparing hospital-at-home to inpatient hospital care ranged from 4 to 38 days). - There is insufficient evidence to determine whether hospital-at-home care, compared with inpatient hospital care, is associated with improved lung function. - The majority of studies did not find significant differences between hospital-at-home and inpatient hospital care for a variety of HRQOL measures at follow-up. The follow-up time point chosen to measure HRQOL, however, may be too late to observe an impact of hospital-at-home care on HRQOL. - Due to limited and inconsistent evidence, conclusions about the effect of hospital-at-home care on length of stay (defined as days in hospital or days in hospital plus hospital-at-home care for inpatient hospital and hospital-at-home, respectively) for the initial exacerbation, could not be determined. - Patient and caregiver satisfaction with care is high for both hospital-at-home and inpatient hospital care.

Project Status: Completed

Year Published: 2012

URL for published report: http://www.hqontario.ca/en/mas/tech/pdfs/2012/rev_COPD_Hospital_at_Home_March.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_copd_hospital_at_home_20120313.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care (MAS)