Review: hospital at home is as effective as inpatient care for mortality and hospital readmissions in patients with acute exacerbations of chronic obstructive pulmonary disease

摘要

Several investigations have compared HaH care with traditional hospital care. Although most studies have shown that HaH is as effective as inpatient care but less costly,the patient populations, inclusion criteria, and endpoints differed. Ram et al pooled the results of 7 studies of patients with COPD who had acute exacerbations. More recen-studies reached similar conclusions.Major strengths of this review include the comprehensive search strategy that was used to identify studies and the well defined inclusion criteria. 2 independent reviewers agreed on the quality of all included RCTs.A limitation of the findings lies in the original research. Although all of the included studies assessed HaH care by a specialist respiratory nursa the frequency and length of care varied, as did ancillary services. Patients randomised to inpatient care received usual care, which varied amorcj hospitals. This variability can make evaluation of endpoints difficult and result in flawed estimates of costs and bed-day savings.The review by Ram et al is relevant to nurses who work in EDs, with respiratory patients, or in home health. Information about cost advantages and patient or family preferences will aid nurses in procuring optimal treatment settings for patients and help to promote early discharge From inpatient settings.