背景:到2020年,全球60岁及以上的成年人超过10亿,占全球人口的13.5%。预测显示,到2050年将增加到21亿。虽然家庭医院(HaH)计划已成为传统常规医院护理的有希望的替代方案,在较低的死亡率等指标上显示出最初的益处,降低再入院率,较短的治疗持续时间,并改善老年人的心理和功能状态,这些影响相对于传统医院设置的稳健性和严重程度需要通过全面的荟萃分析进一步验证.
方法:在2023年4月至6月期间,在PubMed,MEDLINE,Embase,WebofScience,护理和相关健康文献(CINAHL)的累积指数包括RCT和非RCTHaH研究。使用ReviewManager(5.4版)进行统计分析,使用森林地块和I2统计数据来检测研究间的异质性。对于I2>50%,表明纳入研究之间存在实质性异质性,我们采用随机效应模型来解释变异性。对于I2≤50%,我们使用了固定效应模型。对不同健康状况的患者进行了亚组分析,包括癌症,急性医疗条件,慢性疾病,骨科问题,和复杂的医学条件。
结果:本系统综述包括15项试验,包括7个随机对照试验和8个非随机对照试验。结果指标包括死亡率,再入院率,治疗持续时间,功能状态(由Barthel指数衡量),和精神状态(通过MMSE测量)。结果表明,早期出院HaH与死亡率降低有关,尽管有13项研究的低确定性证据支持。它还缩短了治疗时间,得到了7项审判的证实。然而,它对再入院率和精神状态的影响仍然没有定论,分别得到9项和2项试验的支持。功能状态,由Barthel指数衡量,早期放电显示潜在的下降HaH,根据四个试验。亚组分析揭示了类似的趋势。
结论:虽然早期出院HaH在特定指标如死亡率和治疗持续时间方面显示出希望,在重新接纳的情况下,它的效用是模糊的,精神状态,和功能状态,需要对调查结果进行谨慎的解释。
BACKGROUND: The global population of adults aged 60 and above surpassed 1 billion in 2020, constituting 13.5% of the global populace. Projections indicate a rise to 2.1 billion by 2050. While Hospital-at-Home (HaH) programs have emerged as a promising alternative to traditional routine hospital care, showing initial benefits in metrics such as lower mortality rates, reduced readmission rates, shorter treatment durations, and improved mental and functional status among older individuals, the robustness and magnitude of these effects relative to conventional hospital settings call for further validation through a comprehensive meta-analysis.
METHODS: A comprehensive literature search was executed during April-June 2023, across PubMed, MEDLINE, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) to include both RCT and non-RCT HaH studies. Statistical analyses were conducted using Review Manager (version 5.4), with Forest plots and I2 statistics employed to detect inter-study heterogeneity. For I2 > 50%, indicative of substantial heterogeneity among the included studies, we employed the random-effects model to account for the variability. For I2 ≤ 50%, we used the fixed effects model. Subgroup analyses were conducted in patients with different health conditions, including cancer, acute medical conditions, chronic medical conditions, orthopedic issues, and medically complex conditions.
RESULTS: Fifteen trials were included in this systematic review, including 7 RCTs and 8 non-RCTs. Outcome measures include mortality, readmission rates, treatment duration, functional status (measured by the Barthel index), and mental status (measured by MMSE). Results suggest that early discharge HaH is linked to decreased mortality, albeit supported by low-certainty evidence across 13 studies. It also shortens the length of treatment, corroborated by seven trials. However, its impact on readmission rates and mental status remains inconclusive, supported by nine and two trials respectively. Functional status, gauged by the Barthel index, indicated potential decline with early discharge HaH, according to four trials. Subgroup analyses reveal similar trends.
CONCLUSIONS: While early discharge HaH shows promise in specific metrics like mortality and treatment duration, its utility is ambiguous in the contexts of readmission, mental status, and functional status, necessitating cautious interpretation of findings.