When Activity-Based Funding (ABF) for public hospitals begins on 1 July this year, it should make it easier for hospitals to establish Hospital in the Home (HITH) services. The pricing framework underpinning the ABF system stipulates that public hospital services should be priced in a way that facilitates the timely roll-out of evidence-based innovations in the most appropriate care setting.
HITH services have been operating in some Australian hospitals for nearly 20 years. However before starting up a service of their own, many hospital managers will want to know if HITH is safe, and for which patients. This paper briefly outlines the evidence on the safety, quality and costs of HITH services. A list of resources is provided for those who want to know more.
What does the evidence say?
Many health services provide care in patients’ homes. To qualify as a HITH service it must provide active treatment by health care professionals in patients’ homes for conditions that otherwise would require hospital in-patient care. Examples of acute treatments delivered in the home include blood transfusions, intravenous antibiotic treatments for infections, and anticoagulation for patients with deep venous thrombosis and pulmonary emboli.
Some HITH services (early - discharge HITH) also provide subacute treatment such as rehabilitation at home after orthopaedic injuries and procedures. The range of conditions that are treatable at home continues to expand as technology and confidence in HITH improves.
Cochrane Reviews are generally regarded as an authoritative source of research evidence. A systematic review of the evidence on HITH was conducted by the Cochrane Collaboration in 2008 (it was updated in 2011 and no changes were made to the conclusions).
After searching the main medical databases, the Cochrane reviewers found 10 randomised controlled trials (RCTs) that compared HITH with inpatient care; RCTs are generally thought to produce high quality evidence. Data from five of the RCTs on admission - substitution HITH services were broadly comparable, so they were pooled and used to conduct a more high-powered statistical analysis, a meta-analysis.