Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation McCurdy BR. Hospital-at-home programs for patients with acute exacerbations of chronic obstructive pulmonary disease
(COPD): an evidence-based analysis. Toronto: Medical Advisory Secretariat (MAS). Volume 12(10). 2012 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' conclusions 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. Indexing Status Subject indexing assigned by CRD MeSH Home Care Services, Hospital-Based; Humans; Pulmonary Disease, Chronic Obstructive Language Published English Country of organisation Canada English summary An English language summary is available. Address for correspondence Medical Advisory Secretariat, Ontario Ministry of Health and Long Term Care, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 Canada Email: MASinfo.moh@ontario.ca AccessionNumber 32012000633 Date abstract record published 21/09/2012 |