Home Sweet Hospital: Evaluating Evidence Gaps and Future Research Priorities for Hospital at Home

OBJECTIVES: Healthcare systems face significant strain due to growing demand, with urgent and emergency care centers particularly affected. ‘Hospital at Home’ (HaH) has been identified as a potential solution, allowing patients to receive acute care at home or in community settings. HaH facilitates early hospital discharge (step-down care) or prevents hospital admission (step-up care). This research examines the challenges in generating evidence for technology-enabled HaH initiatives and highlights factors for future evaluation.

METHODS: A pragmatic literature review was conducted to assess safety, clinical effectiveness, and cost effectiveness of HaH initiatives. Gap analysis identified priority areas for future research and issues in evidence generation. The authors leveraged their experience from an early value assessment for NICE on virtual wards for acute respiratory infection to inform the review and gap analysis.

RESULTS: Evidence, though limited, suggests HaH is potentially safe and effective. Clinical effectiveness varies by patient cohort and virtual ward model (step-up, step-down, mixed). Most studies were non-comparative or underpowered. Case studies of HaH initiatives in the NHS lacked peer review, involved small samples, and were not transparent about costs. Key issues in evaluation include variability in features between technology-enabled HaH initiatives, population and subgroup differences, and potential distortions in comparison with standard care. Future research should focus on prospective cohort studies to understand clinical and resource outcomes, impacts of different technological features, and true resource use.

CONCLUSIONS: Technology-enabled HaH initiatives are complex interventions. Preliminary evidence suggests that they may benefit healthcare system resources, but comprehensive evaluations are crucial to understand their clinical efficacy, safety, risks and costs. Comprehensive evaluations are vital as HaH initiatives are rapidly implemented across global healthcare systems. Future studies should determine the effectiveness of HaH initiatives across different clinical areas, identify effective features, and be used to determine the optimal implementation and management of HaH in different settings.