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Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence

BMJ 2004; 329 doi: (Published 05 August 2004) Cite this as: BMJ 2004;329:315

This article has a correction. Please see:

  1. Felix S F Ram (fsfram{at}, senior research fellow in respiratory medicine1,
  2. Jadwiga A Wedzicha, professor of respiratory medicine2,
  3. John Wright, consultant in epidemiology and public health medicine3,
  4. Michael Greenstone, consultant respiratory physician4
  1. 1 National Collaborating Centre for Women and Children's Health, London NW1 4RG
  2. 2 Academic Respiratory Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London EC1A 7BE,
  3. 3 Department of Epidemiology and Public Health Medicine, Bradford Hospitals NHS Trust, West Yorkshire BD9 6RJ
  4. 4 Medical Chest Unit, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ
  1. Correspondence to: F S F Ram
  • Accepted 12 May 2004


Objectives To evaluate the efficacy of hospital at home schemes compared with inpatient care in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

Design A systematic review of randomised controlled trials.

Main outcome measure Mortality and readmission to hospital.

Results Seven trials with 754 patients were included in the review. Hospital readmission and mortality were not significantly different when hospital at home schemes were compared with inpatient care (relative risk 0.89, 95% confidence interval 0.72 to 1.12, and 0.61, 0.36 to 1.05, respectively). However, compared with inpatient care, hospital at home schemes were associated with substantial cost savings as well as freeing up hospital inpatient beds.

Conclusions Hospital at home schemes can be safely used to care for patients with acute exacerbations of COPD who would otherwise be admitted to hospital. Clinicians should consider this form of management, especially as there is increasing pressure for inpatient beds in the United Kingdom.


  • We thank Jo Picot (research fellow, Wessex Institute for Health Research and Development, University of Southampton) for her assistance with the review; Nicholson and coauthors17 for providing further data; and Sheree Wellington for copyediting/proof reading the manuscript.

  • Contributors FSFR initiated the idea of the systematic review, wrote the protocol, and conducted the review with input from JW, MG, and JAW at various stages of the review development process. FSFR is guarantor.

  • Funding FSFR received a fellowship from the Netherlands Asthma Foundation for the conduct of this review.

  • Competing interest None declared.

  • Ethical approval Not required.

  • Accepted 12 May 2004
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