PT  - JOURNAL ARTICLE
AU  - Carlos Echevarria
AU  - Karen Brewin
AU  - Hazel Horobin
AU  - Andrew Bryant
AU  - John Steer
AU  - Stephen C. Bourke
TI  - Early supported discharge/hospital at home for exacerbation of chronic obstructive pulmonary disease, A review and meta-analysis
AID  - 10.1183/13993003.congress-2016.PA3772
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA3772
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA3772.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA3772.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - A systematic review and meta-analysis was performed to assess the safety, efficacy and cost of Early Supported Discharge (ESD) and Hospital at Home (HAH) compared to Usual Care (UC) for patients with exacerbation of COPD (ECOPD).The structure of ESD/HAH schemes was reviewed, and analyses performed assuming return to hospital during the acute period (prior to discharge from home treatment) was, and was not, considered a readmission. The pre-defined search strategy included electronic databases, libraries, current trials registers, national organisations, key respiratory journals, key author contact and grey literature. Randomised controlled trials (RCTs) comparing ESD/HAH to UC in patients admitted with ECOPD, or attending the emergency department and triaged for admission, were included. Outcome measures were mortality, all-cause readmissions to six months and cost. Eight RCTs were identified; seven reported mortality and readmissions.The structure of ESD/HAH schemes, particularly selection criteria applied and level of support provided, varied considerably. Compared to UC, ESD/HAH showed a trend towards lower mortality (RR MH= 0.66; 95% CI 0.40–1.09, p= 0.10). If return to hospital during the acute period was not considered a readmission, ESD/HAH was associated with fewer readmissions (RR MH= 0.74, 95% CI 0.60–0.90, p= 0.003), but if considered a readmission, the benefit was lost (RR MH= 0.84; 95% CI 0.69–1.01, p= 0.07). Costs were lower for ESD/HAH than UC. ESD/HAH is safe in selected patients with ECOPD. Further research is required to define optimal criteria to guide patient selection and models of care.