IMPACT OF HOME CARE ON HOSPITAL DAYS - A META ANALYSIS

Objective. To examine the impact of home care on hospital days. Data S ources. 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 additi onal citations. Study Selection. Of 412 articles that examined impact on hospital use/cost, those dealing with generic home care that report ed hospital admissions/cost and used a comparison group receiving cust omary care were selected (N = 20). Study Design. A meta-analytic analy sis used secondary data sources between 1967 and 1992. Data Extraction . Study characteristics that could have an impact on effect size (i.e. , country of origin, study design, disease characteristics of study sa mple, and length of follow-up) were abstracted and coded to serve as i ndependent variables. Available statistics on hospital days necessary to calculate an effect size were extracted. If necessary information w as missing, the authors of the articles were contacted. Methods. Effec t sizes and homogeneity of variance measures were calculated using Dst at software, weighted for sample size. Overall effect sizes were compa red by the study characteristics described above. Principal Findings. 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 o f -.159 and -.379, respectively), depending on the inclusion of a larg e quasi-experimental study with a large: treatment effect. When this o utlier was removed from analysis, the effect size for studies that tar geted terminally ill patients exclusively was homogeneous across study subcategories; however, the effect size of studies that targeted nont erminal patients was heterogeneous, indicating that unmeasured variabl es or interactions account for variability. Conclusion. Although effec t sizes were small to moderate, the consistent pattern of reduced hosp ital days across a majority of studies suggests for the first time tha t home care has a significant impact on this costly outcome.