Hospital at home

BMJ 1998;317:1651 ( 12 December )

Letters

Hospital at home

Schemes evolve gradually

For people with severe mental illness, results are encouraging

Costings were inadequate

Authors' reply

Schemes evolve gradually

The first 150 words of the full text of this article appear below.

EDITOR $---$ In his editorial on hospital at home schemes Iliffe highlights the need for "descriptive studies of the organisationalculture and practice of [such] innovative services" to supplementthe findings of trials.¹ In evaluating a local hospital athome scheme for orthopaedic patients² we put our findings intocontext by obtaining the views of hospital and community basedstaff on the practicality and acceptability of such a service.³

At the outset the staff were ambivalent about the concept of early discharge. Although they were more positive about the conceptonce the service started, many remained negative about the practicalityof running the service. Staffing and financial costs gave riseto particular concerns. Despite apprehension that general practitionersmay face additional burdens, neither the reported studies ⁴ ⁵ nor our own findings support this. We can also confirm Iliffe'ssuggestion that length of stay was sometimes prolonged by delaysin arranging social . . . [Full text of this article]

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Jones, J., Wilson, A., Parker, H., Wynn, A., Jagger, C., Spiers, N., Parker, G. (1999). Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial. BMJ 319: 1547-1550 [Abstract] [Full text]