Authors' objectives: Background Hospital at home (HaH) is a healthcare delivery model that aims to provide hospital-level care in the patient’s home as an alternative to traditional in-hospital care. This can imply admission avoidance or early discharge from hospital with continued hospital-level care at home. HaH is being explored for a wide range of conditions, striving for a costeffective, patient safe, person-centred alternative to in-hospital care with the possibility to stay at home, also in rather severe conditions. Question at issue For adult patients with conditions usually hospitalised (according to current standard of treatment in Sweden) - are there clinical benefits and/or risks of hospital care at home compared to in-hospital care concerning mortality, change in health status, emergency department (ED) visits, complications, health related quality of life (HrQoL), readmission, length of stay, or experience by patients, staff, and close relatives? The search was limited to randomised controlled trials (RCTs).

Authors' results and conclusions: Results A total of 15 RCTs described in 16 publications were included and involved the conditions chronic obstructive pulmonary disease (COPD, 5 RCTs), respiratory tract infections (2 RCTs), heart failure (3 RCTs), neutropenia (1 RCT), and elderly patients with acute deterioration requiring hospital-level care (4 RCTs). The proportion of screened patients considered eligible for HaH ranged from 11% to 70%. Selected patients with acute COPD exacerbation: Three of five included RCTs were assessed to have no major risk of bias. HaH may result in no difference regarding mortality within 3 months follow up compared to in-hospital care (GRADE ⨁⨁OO). For HrQoL and readmission, no significant differences were observed, (low certainty of evidence, GRADE⨁⨁OO). It was not possible to draw any conclusions regarding change in health status, complications, and length of stay (very low certainty of evidence, GRADE ⨁OOO). No data comparing HaH and in-hospital care regarding ED-visits, and experience by patient, staff and relatives were identified. Selected patients with respiratory tract infection: Two small RCTs with some risk of bias were included. It was not possible to draw any conclusions regarding mortality, change in health status, complications, HrQoL, readmission, and length of stay (very low certainty of evidence, GRADE ⊕OOO). No data regarding ED-visits and experience by patients, staff, and close relatives were identified. Selected patients with heart failure: Two of three included RCTs were assessed to have no major risk of bias. It was not possible to draw any conclusions regarding mortality, change in health status, ED-visits, complications, HrQoL, readmission, and caregiver experience. The length of stay may be longer for patients treated in HaH (low certainty of evidence (GRADE⨁⨁OO). No data regarding experience by patients and staff were identified. Selected patients with neutropenia: One study assessed to have major risk of bias was included. The certainty of evidence was considered very low (GRADE ⊕OOO) regarding mortality, complications, HrQoL, readmission and length of stay. No data regarding change in disease, ED-visits, experience by patients, staff, and relatives were identified. Selected elderly patients with acute deterioration: Five publications of four RCTs were included of which two were assessed to have no major risk of bias. HaH may result in no difference regarding mortality within 1 month follow up compared to in-hospital care (GRADE ⨁⨁OO). It was not possible to draw any conclusions regarding change in health status, ED-visits, complications, HrQoL, patient and caregiver experience, and readmission (very low certainty of evidence, GRADE ⊕OOO). HaH may result in a slightly longer length of stay compared to in-hospital care (GRADE ⨁⨁OO). No data regarding staff experience were identified. Conclusion Different settings of HaH have been investigated in RCTs including selected patient populations with COPD, respiratory tract infection, heart failure, neutropenia, and elderly patients with acute deterioration. There are few recent studies, and many studies have limitations regarding directness, risk of bias and precision. Based on identified RCTs there may be no difference in mortality during follow up for the population of selected patients with COPD and selected elderly patients with acute deterioration. For the other populations, no conclusions could be drawn for the key outcomes mortality, and complications. For selected patients with acute COPD exacerbation there may be little or no difference regarding HrQoL and post-discharge readmission rates. HaH may result in a longer length of stay for elderly patients with acute deterioration and in those with heart failure. For all other outcomes no conclusions could be drawn. The patient’s perspective is poorly studied. Economic consequences of HaH for healthcare in VGR were not possible to estimate.

Authors' methods: Methods Three authors performed searches in PubMed, Embase, Cinahl, Web of Science Core Collection and the Cochrane Library in May 2024 with an update in June 2024. They independently assessed the abstracts, and selected in consensus, full-text articles to be considered further by the other authors. Full-text articles were independently assessed for inclusion by four authors with decision in consensus meeting. Included studies were critically appraised, and data extracted. Studies without major risk of bias, if available, formed the basis for conclusions, otherwise conclusions were based on lower quality studies. Meta-analyses were performed if applicable and certainty of evidence was rated according to GRADE.

Project Status: Completed

Year Published: 2025

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-2081313122-157/native/2025_143%20HTA-rapport%20Benefits%20and%20risks%20of%20hospital%20at%20home%202025-06-30.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se