A pioneering service that provides hospital-level care in people’s homes is just as good as being admitted and can avoid unnecessary disruption to older adults, a new study has found.

Researchers concluded the ‘Hospital at Home’ model “can provide an alternative to hospitalisation for selected older persons.”

Under the model, patients receive the same standard of care they would get in a hospital ward, including access to a geriatrician and multi-disciplinary team, medicines, oxygen and intravenous treatment.

Researchers also found a small drop in the chance of admission to a care home among patients who had received Hospital at Home.

In 2011 Scotland’s first Hospital at Home service launched for older people in Lanarkshire.

That service has seen nearly 20,000 patients since it first started and received national awards.

Study author Graham Ellis, a co-founder of the UK Hospital at Home society who helped set up the service in Lanarkshire, said: "Hospital at Home in Scotland has grown rapidly, propelled perhaps by the pandemic and the need to re-evaluate how we provide our healthcare. Patients love the idea of health care that is so patient-centred that it travels to them!

"Being at home with family matters so much to many people and a trip to hospital can be traumatic, confusing or disruptive for the frailest patients. The key question for us was the safety of such care – could we match hospital standards for patients?

"This paper demonstrates that this form of care – acute hospital care for acute conditions, can be provided in the individual's own home just as safely as hospital for certain conditions or certain patients.

"We will of course always need hospitals but adding Hospital at Home to our range of services enables us to meet more people’s needs safely through a variety of services."

The study, led by researchers from the Nuffield Department of Population Health at the University of Oxford, looked at the experiences of more than 1,000 older people across the UK.

It involved patients from hospitals in Lanarkshire, Fife and Lothian, as well as others in Northern Ireland, Wales and England.

Participants had an average age of 83 and nearly three quarters had some form of cognitive impairment, with many reporting difficulties getting around and managing their daily lives.

Six months on from being assigned to either Hospital at Home or hospitalisation, there was little difference in the proportion of people in both groups continuing to live at home and in death rates.

But Hospital at Home patients were slightly less likely to be in long-term residential care (5.7% vs 8.7%).

Study authors suggest this could be explained by hospital-based staff usually being unable to see how the person was getting on at home.

One month on, Hospital at Home patients were slightly less likely, at 1.7% compared to 4.4%, to develop acute confusion, or delirium.

The service scored more highly among patients when it came to waiting times, being in contact with staff and being involved in decisions.

Further analysis is underway to assess whether Hospital at Home is cheaper than traditional hospital models.

Study lead Professor Sasha Shepperd from the Nuffield Department of Population Health, University of Oxford, said: “Our study has produced valuable information to guide policy and healthcare providers.

“Up until now, nobody has known whether to fully invest in Hospital at Home nationwide, or to focus on hospital care. Whether it is more expensive or not, if it means the same or better health outcomes and less disruption for certain patients then we should consider doing it.”

Read more: Insight: Taking hospital to people’s homes; How Hospital at Home is changing patient outcomes

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