title: Should alternatives to conventional hospitalisation be promoted in an era of financial constraint?
abstract: BACKGROUND
  Because the current economic crisis has led to austerity in health policies, with severe restrictions on public health care, avoiding unnecessary admissions and shortening hospital stays is rapidly becoming an urgent priority. Alternatives to hospitalisation replace or shorten hospital processes, including diagnosis, monitoring, treatment and follow-up. This review aims to present the available evidence on alternatives to conventional hospitalisation for medical disorders; options for surgery, psychiatry and palliative care are largely excluded.
  
  
  METHODS
  Narrative review.
  
  
  RESULTS
  The main alternatives to conventional hospitalisation include day centres (DC), quick diagnosis units (QDU), hospital at home (HaH) and, in some circumstances, telemonitoring. DC increase patient comfort, reduce costs and can improve efficiency. In generally healthy patients with suspected severe disease, QDU may be a good alternative to hospitalisation for diagnostic procedures. However, their cost-effectiveness remains to be clearly proven. Randomised controlled trials have shown that hospital-at-home (HaH) can lead to earlier hospital discharges, improve outcomes and reduce costs in patients with prevalent chronic diseases. Although telemonitoring seems to be promising and its use is increasing, methodologically sounder studies with a higher level of evidence are needed to assess its clinical effectiveness.
  
  
  CONCLUSIONS
  Factors such as ageing, the need for an earlier diagnosis of suspected severe disease, the increasing complexity of medical care and the increasing costs of hospitalisation mean that, whenever possible, giving priority to less expensive alternatives to hospital admission, such as QDU, DC, HaH and telemedicine, is an urgent task in the current economic crisis.
authors.affiliation: Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Pericás
authors.forename: Jesús
authors.initials: J
authors.lastname: Aibar
authors.forename: Néstor
authors.initials: N
authors.lastname: Soler
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Soto
authors.forename: Carmen
authors.initials: C
authors.lastname: Sanclemente-Ansó
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics / Q000458:organization & administration; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000191:economics; D019114:Remote Consultation / Q000191:economics / Q000458:organization & administration