Abstract：
OBJECTIVE: To examine randomized controlled trials (RCTs) of \"hospital at home\" (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use of vital sign monitoring approaches and evidence for their effectiveness.
METHODS: Systematic review.
METHODS: This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment, and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices.
METHODS: Eligible studies were identified through updated database and trial registries searches (March 2, 2016, to February 15, 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach.
RESULTS: Twenty-one eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterized: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78-1.12), 3-monthly readmission to hospital RR 1.02 (0.77-1.35), and length of stay mean difference 1.91 days (0.71-3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95% CI 0.11-0.86).
CONCLUSIONS: This review highlights gaps in the reporting and evidence base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.
METHODS: Systematic review.
METHODS: This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment, and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices.
METHODS: Eligible studies were identified through updated database and trial registries searches (March 2, 2016, to February 15, 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach.
RESULTS: Twenty-one eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterized: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78-1.12), 3-monthly readmission to hospital RR 1.02 (0.77-1.35), and length of stay mean difference 1.91 days (0.71-3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95% CI 0.11-0.86).
CONCLUSIONS: This review highlights gaps in the reporting and evidence base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.
摘要：
目的：研究“在家住院”（HAH）的随机对照试验（RCTs），以避免患有急性身体疾病的成年人入院，以确定生命体征监测方法的使用及其有效性的证据。
方法：系统评价。
方法：这篇综述比较了对于患有急性躯体疾病的成年人在避免入院HAH中的生命体征监测策略。生命体征监测可以通过促进安全性来支持HAH急性多学科护理，确定进一步评估的要求，指导临床决策。目前有各种各样的系统可用，包括使用可穿戴设备的可靠和自动化的连续远程监控。
方法：通过更新的数据库和试验注册检索（2016年3月2日至2023年2月15日）确定符合条件的研究，和现有的系统评价。使用Cochrane偏倚风险2工具评估偏倚风险。进行随机效应荟萃分析，并通过生命体征监测方法分层提供叙述摘要。
结果：确定了21个符合条件的RCT（3459名参与者）。生命体征监测的两种方法的特征在于:手动和自动。在大多数分类研究中，报告不足。对于HAH与医院护理相比，6个月死亡风险比(RR)为0.94(95%CI0.78-1.12)，3个月再入院RR1.02（0.77-1.35），和住院时间平均差1.91天（0.71-3.12）。自动监测亚组的再入院率降低（RR0.3095％CI0.11-0.86）。
结论：本综述强调了在提供远程生命体征监测替代急性病入院的报告和证据基础方面的差距。尽管在临床实践中的实施范围不断扩大。尽管使用可穿戴设备进行连续生命体征监测可能会带来额外的好处，其在现有RCT中的使用是有限的。提出了在未来临床试验中实施和评估远程监测的建议。
方法：系统评价。
方法：这篇综述比较了对于患有急性躯体疾病的成年人在避免入院HAH中的生命体征监测策略。生命体征监测可以通过促进安全性来支持HAH急性多学科护理，确定进一步评估的要求，指导临床决策。目前有各种各样的系统可用，包括使用可穿戴设备的可靠和自动化的连续远程监控。
方法：通过更新的数据库和试验注册检索（2016年3月2日至2023年2月15日）确定符合条件的研究，和现有的系统评价。使用Cochrane偏倚风险2工具评估偏倚风险。进行随机效应荟萃分析，并通过生命体征监测方法分层提供叙述摘要。
结果：确定了21个符合条件的RCT（3459名参与者）。生命体征监测的两种方法的特征在于:手动和自动。在大多数分类研究中，报告不足。对于HAH与医院护理相比，6个月死亡风险比(RR)为0.94(95%CI0.78-1.12)，3个月再入院RR1.02（0.77-1.35），和住院时间平均差1.91天（0.71-3.12）。自动监测亚组的再入院率降低（RR0.3095％CI0.11-0.86）。
结论：本综述强调了在提供远程生命体征监测替代急性病入院的报告和证据基础方面的差距。尽管在临床实践中的实施范围不断扩大。尽管使用可穿戴设备进行连续生命体征监测可能会带来额外的好处，其在现有RCT中的使用是有限的。提出了在未来临床试验中实施和评估远程监测的建议。
