Treatments that can be safely and acceptably managed at home need to be defined

EDITOR—Richards et al's and Shepperd et al's definitions of what constitutes hospital in the home care are problematic. 1 2 Richards et al described hospital in the home as “a generic term, referring to a package of home based nursing and rehabilitation services,” while Shepperd et al restricted the eligible groups of patient to patients older than 60 with five broadly defined conditions.

Our concern with these studies is that patients seem to have been selected on the basis of their clinical condition and its burden on the hospital rather than on the basis that their acute hospital based treatment could be appropriately delivered at home. We also wonder whether the selection of conditions for study was determined by the presence of validated research instruments

The appropriate definition of hospital in the home is one in which the patient requires treatment that, without the presence of a hospital in the home delivery system, would otherwise require care in hospital. Substitution of hospital in the home care for acute hospital care is the critical element. In the above papers, the length of stay data showed that the hospital in the home component was additional to the hospital stay rather than a substitute for it.

It …