X1. Home management

The shortage of hospital beds, especially in winter, has prompted interest in home care for management of COPD exacerbations, with involvement of multidisciplinary teams assisting GPs. Such “Hospital in the Home” schemes were studied in a systematic review by Jeppesen (Jeppesen 2012) that included 8 randomised controlled trials which entered patients into a hospital in the home scheme within 72 hours of presenting to hospital.  The review found that compared to standard care, participants allocated to hospital in the home were significantly less likely to be readmitted to hospital within the next 1 to 6 months (risk ratio=0.76, 95% CI 0.59 to 0.99) [evidence level I].  There was no significant difference in mortality (risk ratio=0.65, 95% CI 0.40 to 1.04), and while there was no difference in satisfaction levels for patients or carers, these comparisons were based on small numbers. Economic studies of such programs have shown mixed results.