Hospital at home scheme is acceptable alternative to hospital care and is cost effective

The Leicester hospital at home scheme was set up to prevent acute hospital admission by providing a home based alternative. On p 1542 Wilson et al report a trial in which patients were randomised to either hospital at home or inpatient care. Clinical outcomes were similar, but patients randomised to hospital at home required about 45% fewer days in care over the three month study period. The authors conclude that hospital at home can provide an effective and acceptable alternative to hospital admission. A parallel economic evaluation also shows that hospital at home can be cost effective (p 1547). In an intention to treat analysis, costs in hospital and hospital at home were very similar. About a quarter of patients randomised to hospital, however, chose not to be admitted, and when these cases were excluded, hospital at home provided an episode of care more cheaply. This difference was sustained during a three month follow up period.

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