Advanced home health care and home rehabilitation

Assessment Objective

The report addresses advanced home health care, ie, medical care in the home, as an alternative to hospital care. On-call physicians and healthcare staff must be available for home visits around-the-clock, and hospital care must be available as needed. Furthermore, the report addresses home rehabilitation services which can shorten the hospital length of stay and replace daycare. Home rehabilitation may also be extended to substitute for some outpatient rehabilitation services.

Most home health care focuses on palliative care in treating cancer and other diseases, but care for pulmonary diseases, acute geriatric and neurological disorders, and pediatric problems are also included. Home rehabilitation is provided to patients suffering from stroke and following orthopedic surgery.

The main question is whether advanced home health care and home rehabilitation services are superior to, or less expensive than, hospital-based services.

Assessment Strategy

Systematic literature review focusing on the costs and effects.

Primary Data Collection

In 1998, Spri was commissioned by SBU to inventory home health care and home rehabilitation in Sweden and to analyze the costs associated with these services.

Data Criteria; Types of Studies Included

>A literature search was conducted for the period 1965 to 1999. Reference lists were reviewed. Controlled studies, preferably randomized, meta-analyses, and review articles which met predetermined quality criteria were included.

Review of Publications

At least two individuals reviewed and assessed the literature quality for each chapter. A lay group was asked for opinions on current issues and problems. The manuscript was revised internally by the project group, and thereafter by four external reviewers. Following further revision, the report was submitted to the SBU Scientific Advisory Committee and Board of Directors for further viewpoints and suggestions for revision.

Report Contents

Advance home health services are offered from approximately 50 sites in Sweden which provide care to between 10 000 and 12 000 patients annually. Most care is delivered to patients in late stages of cancer, but one third of the patients suffer from chronic diseases involving the pulmonary and circulatory systems.

Total costs have been estimated at approximately 580 million SEK. All examinations covered in this report deal with care delivered for shorter periods of time. In palliative care and the care of children, both patients and family members expressed greater satisfaction with home health services than with hospital care. Otherwise, the results were comparable. There is no scientific evidence to show that home health care results in either higher or lower total costs than other care alternatives. Therefore, at this time, free choice and quality should be the guiding principles in planning advance home health services.

Approximately 5 000 patients receive home rehabilitation services, mainly after stroke and hip surgery. The annual costs are approximately 44 million SEK. Home rehabilitation provides comparable results as alternative forms of rehabilitation as regards patients quality of life and ability to care for themselves. Costs were also comparable. In home rehabilitation, freedom of choice and local conditions should determine how to best organize this type of care.