The prestigious Dhole-Eddlestone Memorial Prize has been awarded for the paper ‘Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?. The prize is given annually for the most deserving medical research relating to the needs of older people published over the last year in Age and Ageing, the scientific journal of the British Geriatrics Society (BGS).
The paper, published in December 2021, explored the health outcomes and potential cost savings associated with ‘Hospital at Home’, a service providing hospital-level care for acute conditions in an older person’s home, compared to hospital admission. This paper provides vital evidence for use by decision makers in the design, planning and provision of healthcare services for older people and has informed the roll-out of virtual wards.
Sasha Shepperd, Professor of Health Services Research at Oxford Population Health, led the research team which investigated the cost-effectiveness of ‘Hospital at Home’ compared to hospital admission. The randomised controlled trial recruited over 1,000 older patients who would normally have been referred to hospital for an unplanned admission (average age 83 years) from across the UK. Participants were randomly assigned to receive either hospital inpatient or Hospital at Home care with direct healthcare costs such as staff time, medicines, transport and consultations recorded.
Researchers also took into account social care costs such as residential care, and societal costs such as lost productivity by informal carers. Their results showed that Hospital at Home was less costly than inpatient care with an average cost reduction of £2,260 per patient, and much of that saving relating to social care costs. Health outcomes, measured in terms of quality of life and survival at six months, were similar in the two groups.
This study’s conclusion that a 'Hospital at Home’ service with a focus on multi-dimensional assessment has the potential to provide cost savings without compromising health outcomes is of major significance. Some conditions require hospital admission. Hospital at Home provides care substantially beyond that traditionally delivered in domestic settings, but only within the clinical team’s scope. In light of the unprecedented operational and economic pressures faced by the NHS, it is paramount that safe, effective alternatives to bed-based hospital care are identified, and that the potential economic benefits are supported by evidence.
The timing of this publication in Age and Ageing has allowed the rapid uptake of this evidence to support the roll out of virtual wards that include frailty hospital at home. Prior to this paper’s publication, the vast majority of studies addressed clinical outcomes and patient perceptions of Hospital at Home, with limited research supporting the financial benefits. This study’s focus on the financial benefits of Hospital at Home makes its findings highly relevant to the wider fields of health policy and economics.
Professor Shepperd said ‘My colleagues and I are hugely honoured to receive this award. We would like to send our thanks to the many healthcare professionals across the UK involved with Hospital at Home services, who shared local innovations and their experience of delivering high-quality care in people’s homes, and who supported the recruitment of older people to this study; and to the older people who participated in this research. We would also like to thank Age and Ageing for publishing this new evidence that Hospital at Home has the potential to further strengthen the provision of healthcare services for older people by offering an alternative to hospital admission.’
Professor Rowan Harwood, Editor in Chief of Age and Ageing commented ‘Hospital at home is one of the most important developments of recent decades. For suitable patients and properly constituted teams, it provides a preferable alternative to hospital in many ways. It is liked by many patients and costs less when health and social care expenditure are considered together. Large scale trials to evaluate cost effectiveness allow us to prioritise innovations like this against other services. We are delighted to have published this paper and awarded it the Dhole-Eddlestone Prize, and we congratulate the authors on their achievement.’
Professor Graham Ellis, Past President of the UK Hospital at Home Society, commented ‘The provision of Comprehensive Geriatric Assessment (CGA) has changed by necessity over the decades and we need to constantly refine how we provide services to older people. In the current context, ‘better’ is no longer good enough and services need to be sustainable, which means that looking at simple cost effectiveness becomes part of a new triple bottom line of quality, safety and cost effectiveness. Hospital at Home appears to be one of those rare services that is as safe, preferred and more cost effective, suggesting that the future of care planning for older people is both doable and sustainable.’
The Dhole-Eddlestone Memorial Prize is funded by a legacy from Dr Manindra Kumar Dhole, a BGS member who died in 1977. The name of the prize commemorates the anniversary of his marriage with Dr Eddlestone. One cash prize of £1,000 is made each year and announced to coincide with the anniversary of the date of their marriage.
Read more about Hospital at Home in a blog on the BGS website.