背景:早期放電醫院在國內是一個服務,它提供衛生保健專業人士積極治療的病人的家庭條件,否則需要急性醫院住院治療。這是一個更新的科克倫審查。

目的:確定患者的有效性和成本管理早期放電醫院在家而住院的醫院護理。

搜索方法:我們搜索以下數據庫2017年1月9日:Cochrane有效的實踐和組織護理組(EPOC)登記,科克倫中心注冊的對照試驗(中央)、MEDLINE、Embase, CINAHL, EconLit。我們搜查了臨床試驗注冊中心。

選擇標準:隨機試驗比較早期放電醫院在家急性醫院住院病人照顧的成年人。我們排除產科、兒科、精神衛生醫院在家裏計劃。beplay体育相关新闻數據收集和分析:我們跟著科克倫和EPOC預期的標準方法的程序。我們用身體的等級評估方法確定的證據最重要的結果。

主要結果:我們包括32試驗(N = 4746), 6個新的更新,主要是在高收入國家開展的。我們認為大部分的研究有一個低或不清楚風險的偏見。幹預是由醫院外展服務(17個試驗),以社區為基礎的服務(11個試驗),由醫院協調中風團隊或醫生與社區服務在四個試驗。研究招募人們康複strokeEarly放電醫院在家裏可能很少或根本沒有區別在三到六個月死亡率(風險率(RR) 0.92, 95%可信區間(CI) 0.57到1.48,N = 1114, 11個試驗,moderate-certainty證據),可能很少或根本沒有區別再入院的風險(相對危險度1.09,95%可信區間0.71到1.66 N = 345, 5試驗,確定性的證據)。醫院在家裏可能會降低生活的風險機構設置在六個月(相對危險度0.63,96%可信區間0.40到0.98;N = 574 4試驗,確定性的證據)和可能稍微提高病人滿意度(N = 795,確定性的證據)。醫院在家裏可能降低了醫院的住院時間,moderate-certainty證據發現,國內的人分配到醫院解除幹預大約7天前比人們接受住院治療(95%可信區間10.19到3.17天前,N = 528, 4試驗)。在家也不確定醫院對成本有影響(非常低確定性的證據)。研究招募患者的醫療conditionsEarly放電醫院在家裏可能很少或根本沒有區別死亡率(相對危險度1.07,95%可信區間0.76到1.49;N = 1247、8試驗、moderate-certainty證據)。 In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people undergoing elective surgeryThree studies did not report higher rates of mortality with hospital at home compared with inpatient care (data not pooled, N = 856, low-certainty evidence; mainly orthopaedic surgery). Hospital at home may lead to little or no difference in readmission to hospital for people who were mainly recovering from orthopaedic surgery (N = 1229, low-certainty evidence). We could not establish the effects of hospital at home on the risk of living in institutional care, due to a lack of data. The intervention might slightly improve patient satisfaction (N = 1229, low-certainty evidence). People recovering from orthopaedic surgery allocated to early discharge hospital at home were discharged from the intervention on average four days earlier than people allocated to usual inpatient care (4.44 days earlier, 95% CI 6.37 to 2.51 days earlier, , N = 411, 4 trials, moderate-certainty evidence). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).

作者的結論:盡管越來越感興趣的潛在的早期放電醫院在國內服務作為一個便宜的選擇住院治療,本文提供了證據不足的經濟效益(通過減少醫院住院時間)或改善健康結果。