New research led by Oxford Population Health has shown that treating certain older patients at home, rather than in hospital, can both save money and improve patient outcomes. The results are published today in Age and Ageing.
Ageing populations worldwide are resulting in increasing numbers of older people each year requiring hospital-level care, prompting an urgent search for alternatives for hospital-based treatment. Besides the pressure that hospital admission places on wards, there are concerns that hospitalisation may increase the risk of delirium (confusion) and a loss of independence for older people.
An alternative to hospital admission is a ‘Hospital at Home’ arrangement, where hospital-standard care is provided to a selected group of older patients in their homes. As in a hospital ward, patients have access to a geriatrician and multi-disciplinary team; medicines, oxygen and intravenous treatment may be provided; and they can be transferred to hospital if required.
Previous research from Oxford Population Health has demonstrated that Hospital at Home care can result in just as good clinical outcomes or better for certain older patients. In addition, Hospital at Home care was associated with slightly fewer patients moving into residential care after treatment, greater satisfaction with care and (for some patients) less disruption to existing care packages.
But without any evidence on how the cost-effectiveness of Hospital at Home compares with hospital-based care, health service providers cannot decide whether to invest in these services. To investigate this, researchers from Oxford Population Health compared the cost-effectiveness of Hospital at Home with hospital inpatient treatment for older people who participated in a randomised controlled trial. This recruited over 1,000 older patients (average age 83 years) from across the UK between March 2015 and June 2018. Participants had been referred for hospital admission for many different reasons that included acute functional decline or infection (but not more severe health issues, such as a heart attack). After agreeing to take part in the trial, they were randomly assigned to receive either hospital inpatient or Hospital at Home care.
The direct healthcare costs in the analysis included staff time, medicines, transport, consultations, outpatient appointments and (for hospital inpatients) hospital overheads. These were combined with social care costs, such as residential care, community services and home care services, up to six months after patients were recruited to the study.
The results showed that, overall, Hospital at Home was less costly than hospital admission, with an average cost reduction of £2,265 per patient (reduced from an average hospital cost per patient of £17,390 to £15,124 for Hospital at Home).
Importantly, despite these cost savings, Hospital at Home care was not associated with worse patient outcomes, including quality of life and survival after six months.
Professor Sasha Shepperd (Oxford Population Health), who led the research, said: ‘Our study strengthens the evidence base to support the addition of Hospital at Home care as a cost-effective alternative to hospital admission for selected older people. Wider use of Hospital at Home services could therefore expand the health services available to an older population and reduce the burden on hospitals and residential care.’