Ziekenhuisopnamevervangende zorg; een literatuurstudie naar effecten van een vorm van transmurale zorg

To evaluate the effects of hospital at home on health outcomes and quality of life of patients and carers; to evaluate the costs of this form of care and the experiences of the (para)medics involved.

Design

Literature study.

Method

Using Medline, EMBASE-Excerpta Medica, Scisearch and Cinahl, a search was carried out for Dutch- and English-language studies from 1990-2001 which compared hospital at home with conventional inpatient care.

Results

Twenty-seven (randomised) controlled trials and cross-over studies from seven different countries were found, which resulted in 37 publications. No differences were found in health outcomes between patients allocated to hospital at home and inpatient care, providing there was careful patient selection and the home met a number of basic conditions. Patients and their carers rated hospital at home positively. The expected reduction in costs to the health services was disappointing. Good organisation, communication and funding were essential boundary conditions to the success of this form of care. Health benefits appear to be primarily attained with schemes designed to avoid admission to hospital for the elderly.