Home hospital care benefits patients with acute conditions
Among patients with acute conditions, hospital care at home reduced costs, health care use and readmission and increased physical activity compared with usual care, according to a study published in the Annals of Internal Medicine.
“The home hospital model aims to get the right care to the right patient at the right time in the right place,” David M. Levine, MD, MPH, MA, an instructor in medicine at Brigham and Women’s Hospital, and colleagues wrote.
Levine and colleagues’ home hospital care intervention included a visit from a general internist and two visits from a home health registered nurse daily. Additional care from home health aides, social workers, physical therapists and occupational therapists was available to patients at home, and certain specialists were available for telemedicine consultations.
Patients wore a small skin patch to continuously monitor their temperature, respiratory rate, telemetry, movement and falls. At home, patients could receive respiratory therapies, IV medications with an infusion pump, in-home radiology and blood diagnostics.
Once enrolled in the study, participants were randomly assigned to receive home hospital care or usual care.
Researchers found that among the 91 patients enrolled in the study, the adjusted mean cost of acute care episode was 38% lower (95% CI, 24-49) in home care patients compared with usual care patients.
Home care patients had fewer laboratory orders than usual care patients, with a median of three orders per admission vs. 15 orders per admission. Compared with control patients, home patients also had fewer imaging studies (median, 14% vs. 44%) and fewer consultations (median, 2% vs. 31%).
Safety events occurred in 9% of home patients and 15% of control patients.
Researchers found that compared with those who received usual care, home patients were typically less sedentary (median percentage of day, 12% vs. 23%) and spent less time lying down (median percentage of day, 18% vs. 55%).
Readmission within 30 days of discharge was less common among home patients (7%) than usual care patients (23%).
In an editorial accompanying the study, John B. Wong, MD, and Joshua T. Cohen, PhD, of Tufts Medical Center, wrote that this study and others on home hospital care suggest that “it is one approach to addressing existing inefficiencies, fragmented care, and high costs in the United States.”
“Moving to and reimbursing for innovative approaches to health care delivery and financing, such as hospital care at home, will help appropriate selected patients receive the care they need where they want it,” they continued. – by Erin Michael
Disclosures: Levine reports funding through Biofourmis to perform a machine learning study of home-based acute care monitoring. Please see study for all other authors’ relevant financial disclosures. Cohen reports personal fees from Abbvie, Axovant, Novartis, Partnership for Health Analytic Research, Pharmerit, Precision Health Economics, Sage Therapeutics and Sarepta Therapeutics and grants from AdvaMed, Bluebird Bio, Genentech, Lundbeck, Merck, Personalized Medicine Coalition, PhRMA Foundation and Vertex outside the submitted work. Wong reports no relevant financial disclosures.