title: Early Supported Discharge/Hospital At Home For Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Review and Meta-Analysis.
abstract: A systematic review and meta-analysis was performed to assess the safety, efficacy and cost of Early Supported Discharge (ESD) and Hospital at Home (HAH) compared to Usual Care (UC) for patients with acute exacerbation of COPD (AECOPD). The structure of ESD/HAH schemes was reviewed, and analyses performed assuming return to hospital during the acute period (prior to discharge from home treatment) was, and was not, considered a readmission. The pre-defined search strategy completed in November 2014 included electronic databases (Medline, Embase, Amed, BNI, Cinahl and HMIC), libraries, current trials registers, national organisations, key respiratory journals, key author contact and grey literature. Randomised controlled trials (RCTs) comparing ESD/HAH to UC in patients admitted with AECOPD, or attending the emergency department and triaged for admission, were included. Outcome measures were mortality, all-cause readmissions to 6 months and cost. Eight RCTs were identified; seven reported mortality and readmissions. The structure of ESD/HAH schemes, particularly selection criteria applied and level of support provided, varied considerably. Compared to UC, ESD/HAH showed a trend towards lower mortality (RRMH = 0.66; 95% CI 0.40-1.09, p = 0.10). If return to hospital during the acute period was not considered a readmission, ESD/HAH was associated with fewer readmissions (RRMH = 0.74, 95% CI: 0.60-0.90, p = 0.003), but if considered a readmission, the benefit was lost (RRMH = 0.84; 95% CI 0.69-1.01, p = 0.07). Costs were lower for ESD/HAH than UC. ESD/HAH is safe in selected patients with an AECOPD. Further research is required to define optimal criteria to guide patient selection and models of care.
authors: a Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , Newcastle Upon Tyne , United Kingdom.
authors: Carlos
authors: C
authors: Echevarria
authors: b Critical Care and Respiratory Medicine Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital , Northumberland , United Kingdom.
authors: Karen
authors: K
authors: Brewin
authors: c Sheffield Hallam University , Sheffield , United Kingdom.
authors: Hazel
authors: H
authors: Horobin
authors: d Institute of Health and Society, Newcastle University , Newcastle Upon Tyne , United Kingdom.
authors: Andrew
authors: A
authors: Bryant
authors: e Research and Development Department, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , Newcastle Upon Tyne , United Kingdom.
authors: Sally
authors: S
authors: Corbett
authors: a Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , Newcastle Upon Tyne , United Kingdom.
authors: John
authors: J
authors: Steer
authors: a Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , Newcastle Upon Tyne , United Kingdom.
authors: Stephen C
authors: SC
authors: Bourke
mesh_terms: D003362:Cost-Benefit Analysis; D019468:Disease Management; D018450:Disease Progression; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D009026:Mortality; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
keywords: COPD; Hospital at Home; cost; mortality; readmission