Acute care hospital at home: a focused narrative review of health economics, system-level impacts, and a logic model for future research

Hospital-at-home (HaH) models, which deliver acute hospital-level care in a patient’s usual residence, are increasingly adopted as alternatives to traditional inpatient care. This focused narrative review is a synthesis of best current evidence on the health economic outcomes of HaH, including cost-effectiveness and resource utilisation, alongside its clinical and safety impacts, such as mortality, readmission rates, and patient safety incidents. It also explores the experiences of patients, carers, and staff, which are generally positive but underscore challenges such as carer burden. Key factors that will aid implementation, in the future, include digital technologies and dedicated workforce development. This model has the potential to benefit in alleviating health inequity. HaH offers suitable patients the potential for improved satisfaction, shorter hospital admissions, and economic savings. However, it must be noted that these benefits depend on appropriate patient selection, service design and local context – which can be ensured through appropriate education on HaH. Methodological limitations in the published research with evidence gaps remain, particularly regarding long-term societal costs and equitable access for HaH. The article introduces a comprehensive logic model to conceptualise HaH as a complex intervention and to guide future research aimed at optimising quality, safety, and value across diverse healthcare systems. This focused review prioritises a narrative approach on UK National Health Service relevant policy, national evaluations, and key systematic reviews instead of focusing on a systematic, fully replicable search given the heterogeneity of HaH literature.