title: A meta-analysis of "hospital in the home".
abstract: OBJECTIVE
  To assess the effect of "hospital in the home" (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.
  
  
  METHODS
  MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years.
  
  
  METHODS
  Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist.
  
  
  RESULTS
  61 RCTs met the inclusion criteria. HITH care led to reduced mortality (odds ratio [OR], 0.81; 95% CI, 0.69 to 0.95; P = 0.008; 42 RCTs with 6992 patients), readmission rates (OR, 0.75; 95% CI, 0.59 to 0.95; P = 0.02; 41 RCTs with 5372 patients) and cost (mean difference, -1567.11; 95% CI, -2069.53 to -1064.69;  P < 0.001; 11 RCTs with 1215 patients). The number needed to treat at home to prevent one death was 50. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies; carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00; 95% CI, -0.19 to 0.19).
  
  
  CONCLUSIONS
  HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden.
authors.affiliation: Post Acute Care Services, Prince of Wales Hospital, Sydney, NSW. g.caplan@unsw.edu.au
authors.forename: Gideon A
authors.initials: GA
authors.lastname: Caplan
authors.forename: Nur S
authors.initials: NS
authors.lastname: Sulaiman
authors.forename: Dee A
authors.initials: DA
authors.lastname: Mangin
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Aimonino Ricauda
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Wilson
authors.forename: Louise
authors.initials: L
authors.lastname: Barclay
mesh_terms: D003362:Cost-Benefit Analysis; D018575:Home Care Services, Hospital-Based / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D057194:Intention to Treat Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*