Data that will reassure advocates—but without satisfying the sceptics

General practice pp 1786, 1791, 1796, 1802

Hospital at home schemes providing care in the patient's home that is traditionally provided in hospital have grown in importance in health services in both Europe and North America and are seen as a possible substitute for inpatient care in the National Health Service.1 The limited experience of hospital at home developments in the United Kingdom suggests that savings can be made when such services are substituted for usual hospital care, at least for some patient groups,2 but a recent systematic review of the English language literature provides little evidence to support this innovatory approach to acute care.3 Few trials of hospital at home services have, however, been done, and most have been small, with no consistency in outcome measures and little attempt at economic evaluation.

The many purchasers and providers planning hospital at home schemes4 have had little guidance on how to proceed, with the result that many recent attempts to create this type of service have been unplanned experiments. Economic evaluation of some new hospital at …