Impact of home care on hospital days : a meta analysis

• Published in: Health services research Vol. 32; no. 4; pp. 415 - 432
• Main Authors: HUGHES, S.L, ULASEVICH, A, WEAVER, F.M
• Format: Journal Article
• Language: English
• Published: Ann Arbor, MI Health Administration Press 01.10.1997; Health Research and Educational Trust; Blackwell Publishing Ltd
• Subjects: Aged; Biological and medical sciences; Care and treatment; Child; Child Health Services - economics; Child Health Services - statistics & numerical data; Citations; Cost analysis; Cost control; Costs and Cost Analysis; Effect Modifier, Epidemiologic; Effects; Elderly; Health Services for the Aged - economics; Health Services for the Aged - statistics & numerical data; Home care services; Home care services industry; Home Care Services, Hospital-Based - economics; Home Care Services, Hospital-Based - statistics & numerical data; Home Care Services, Hospital-Based - utilization; Home health care; Hospice care; Hospice Care - economics; Hospice Care - statistics & numerical data; Hospital stays; Hospital utilization; Hospitals; Humans; Length of stay; Length of Stay - economics; Length of Stay - statistics & numerical data; Medical sciences; Medicare; Mental Health Services - economics; Mental Health Services - statistics & numerical data; Miscellaneous; Mortality; Nursing homes; Pediatrics; Public health. Hygiene; Public health. Hygiene-occupational medicine; Statistical analysis; Studies; United States > US; Hospitalization; Day hospital; Databank; At home
• ISSN: 0017-9124; 1475-6773

To examine the impact of home care on hospital days. Search of automated databases covering 1964-1994 using the key words "home care," "hospice," and "healthcare for the elderly." Home care literature review references also were inspected for additional citations. Of 412 articles that examined impact on hospital use/cost, those dealing with generic home care that reported hospital admissions/cost and used a comparison group receiving customary care were selected (N = 20). A meta-analytic analysis used secondary data sources between 1967 and 1992. Study characteristics that could have an impact on effect size (i.e., country of origin, study design, disease characteristics of study sample, and length of follow-up) were abstracted and coded to serve as independent variables. Available statistics on hospital days necessary to calculate an effect size were extracted. If necessary information was missing, the authors of the articles were contacted. Effect sizes and homogeneity of variance measures were calculated using Dstat software, weighted for sample size. Overall effect sizes were compared by the study characteristics described above. Effect sizes indicate a small to moderate positive impact of home care in reducing hospital days, ranging from 2.5 to 6 days (effect sizes of -.159 and -.379, respectively), depending on the inclusion of a large quasi-experimental study with a large treatment effect. When this outlier was removed from analysis, the effect size for studies that targeted terminally ill patients exclusively was homogeneous across study subcategories; however, the effect size of studies that targeted nonterminal patients was heterogeneous, indicating that unmeasured variables or interactions account for variability. Although effect sizes were small to moderate, the consistent pattern of reduced hospital days across a majority of studies suggests for the first time that home care has a significant impact on this costly outcome.