Efficacy and Safety of Hospital-at-Home versus Traditional Hospital Care in Older Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Introduction: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of the Hospital-at-Home (HaH) model compared to traditional hospital care for older patients.

Methods: We comprehensively searched PubMed, Embase, Medline, Cochrane Library, SinoMed, Scopus, and ClinicalTrials.gov for randomized controlled trials (RCTs) published up to April 15, 2024. The primary outcomes were length of stay (LOS) and readmission rates. Secondary outcomes included total cost, mortality, adverse events, and instrumental activities of daily living (IADL).

Results: Eleven RCTs involving 3,301 patients were included. The HaH group demonstrated a significantly shorter LOS (SMD = -0.45; 95% CI: -0.62 to -0.28; p < 0.01) and lower total healthcare costs (SMD = -0.40; 95% CI: -0.52 to -0.28; p < 0.0001) than the traditional care group. HaH was also associated with a reduced risk of readmission, with subgroup analyses showing consistent benefits at 1, 3, and 9 months. Additionally, patients receiving HaH showed modest but significant improvements in IADL scores (SMD = -0.15; 95% CI: -0.26 to -0.04; p < 0.0001). However, no significant differences were found between the two groups in terms of mortality (RR = 1.03; 95% CI: 0.49-2.18; p = 0.93) or adverse event rates (RR = 1.01; 95% CI: 0.43-2.36; p = 0.084).

Conclusion: For a selected group of older patients, HaH appears to be a viable alternative to traditional hospitalization, offering advantages in reducing LOS, healthcare costs, and readmission rates, while potentially improving functional recovery without increasing risks to patient safety. Further research is warranted to confirm these findings and refine implementation strategies.

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