title: Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence.
abstract: OBJECTIVE
  To evaluate the efficacy of hospital at home schemes compared with inpatient care in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A systematic review of randomised controlled trials.
  
  
  METHODS
  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.
authors.affiliation: National Collaborating Centre for Women and Children's Health, London NW1 4RG. fsfram@yahoo.co.uk
authors.forename: Felix S F
authors.initials: FS
authors.lastname: Ram
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.forename: Michael
authors.initials: M
authors.lastname: Greenstone
mesh_terms: D000208:Acute Disease; D018575:Home Care Services, Hospital-Based / Q000592:standards*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome