Sunday, April 14, 2024

First Systematic Review on Technology-Enabled Inpatient-Level Care at Home Services

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The rapid implementation of technology-enabled inpatient-level care at home services, including virtual wards and hospitals at home, has been explored in a systematic review. The review is the first of its kind to connect the components of these service delivery innovations to evidence of their effectiveness, to explore implications for practice and research.

The systematic review included a search of multiple databases, recommended by Cochrane, up until 30 November 2022. It also included additional resources for randomized and non-randomized studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. The interventions were classified into care model groups using three key components: clinical activities, workforce, and technology. Evidence was synthesized by these groups quantitatively or narratively for mortality, hospital readmissions, cost-effectiveness, and length of stay.

Comparative Study Review Suggests Home Care Technologies May Reduce Hospital Readmissions with Uncertain Impact on Mortality

The review incorporated 69 studies: 38 randomized studies (6413 participants; largely judged as low or unclear risk of bias) and 31 non-randomized studies (31,950 participants; largely judged as serious or critical risk of bias). The studies described 63 interventions which formed eight model groups. Most models, regardless of using low- or high-intensity technology, may have similar or reduced hospital readmission risk compared with hospital-based inpatient care (low-certainty evidence from randomized trials).

For mortality, most models had uncertain or unavailable evidence. Two exceptions were low technology-enabled models that involve hospital- and community-based professionals, they may have similar mortality risk compared with hospital-based inpatient care (low- or moderate-certainty evidence from randomized trials).


Low-Tech, Technology-Enabled Home Care Proves Cost-Effective for COPD Without Increased Risks

The cost-effectiveness evidence for high technology-enabled models is unavailable. However, sparse evidence suggests that low technology-enabled multidisciplinary care, delivered by hospital-based teams, could be more cost-effective than hospital-based care for those with chronic obstructive pulmonary disease (COPD) exacerbations.

The review suggests that none of the technology-enabled care-at-home models explored put people at a higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to the use of technology-enabled at-home models. It is unclear whether inpatient-level care at home using higher levels of technology provides additional benefits. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation.


Original article: Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components. BMC Med. 2024 Apr 2;22(1):145. doi: 10.1186/s12916-024-03312-3. PMID: 38561754.

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