Comparison of hospital-at-home and in-hospital hospitalizations of randomized controlled studies – a systematic review and meta-analysis
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Background: Several studies demonstrated clinical and economic benefits of hospital-at- home (HaH), but using different methods, study groups, and indications, the results are unequivocal. Our systematic review and meta-analysis include only randomized- controlled studies comparing outcomes of HaH with those of regular in-patient hospitalizations. Aim: To compare outcomes of HaH with those of regular hospitalization. Methods: English Medical literature searches were conducted for Hospital-at- Home compared to In-Hospital hospitalization in randomized, controlled studies (RCTs). Searches were performed in PubMed, EMBASE, Scopus, and CENTRAL. Meta-analysis was performed and pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Heterogeneity was evaluated and I2 statistic was used to measure the proportion of inconsistency in individual studies. We also calculated a potential publication bias. Results: 14 randomized controlled studies representing 43 sub-studies were selected according to the inclusion criteria. The odds ratio of "hospital-at-home" and "in-hospital" comparison was 0.638 95% CI 0.512 to 0.796. In the issues of clinical outcomes, HaH was found to be non-inferior than a regular hospital, but much better in patient preference with OR 0.396 95% CI 0.277 to 0.566 for worse outcomes. Heterogeneity and inconsistency were small, with no significant publication bias. Conclusion: This meta-analysis showed that HaH may be recommended for patient hospitalization when needed, according to the specific indications and patients matching to HaH criteria.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.