A new study from Brigham and Women's Hospital found a home hospital model of care reduced cost while maintaining standards of care compared to typical in-hospital care.
David Levine, MD, MPH
Results of a pilot study from Brigham and Women’s Hospital suggest a home hospital model of care could reduce cost, health care use, and readmissions as well as boost physical activity.
The randomized controlled trial provides evidence backing the concept of home hospital care for patients with acute illness—a large hurdle for proponents of the approach, according to study investigators.
"This work cements the idea that, for the right patients, we can deliver hospital-level care outside of the four walls of the traditional hospital and provides more of the data we need to make home hospital care the standard of care in our country," said investigator David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital.
To further explore the concept of substitutive hospital-level care in a patient’s home, investigators conducted a trial comporting outcomes to that of patients receiving usual hospital care in a group of 91 patients. The parallel-design, randomized controlled trial included acutely ill patients with a multitude of conditions including infection, heart failure exacerbation, chronic obstructive pulmonary disease exacerbation, and asthma exacerbation.
To be eligible for inclusion, participants had to live within a 5-mile area of Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital. Other inclusion criteria included being 18 or older and having the capacity to consent. Of the 91 patients included, 43 were randomized to home are and 48 were used as controls and received usual hospital care.
All patients randomized to home hospital are received at least 1 daily visit from an attending general internists and 2 daily visits from a home health registered nurse. Specialists could be consulted via telemedicine and the services of a home health aide, social worker, physical therapist, or occupational therapist were available if needed.
The primary outcome of the study was the total diet cost of the acute care episode, which was defined as the sum of costs for non-physician labor, supplies, mediations, and diagnostic tests. Secondary outcomes included health care use and physical activity during the acute care episode and at 30 days.
Upon analyses, investigators observed the adjusted mean most of an acute care episode was 38% less for patients receiving home care compared to those receiving in-hospital care. Furthermore, home patients had fewer laboratory orders (median per admission, 3 versus 15), imaging studies (median, 14% versus 44%), and consultations than their in-hospital counterparts (median, 2% versus 31%).
In regard to activity, results indicated home patients spent a smaller proportion of time sedentary (median, 12% versus 23%) or lying down (median, 18% versus 55%). Patients in the home group were readmitted less frequently within 30 days (7% versus 23%). Additionally, investigators pointed out safety events were noted in 15% of control patients and 9% of home patients. Scores in both groups indicated high global satisfaction with care.
Based on the results of the trial, the study was stopped early in light of local needs to quickly increase home hospital capacity after positive interim results. Levine noted how the results of the study indicate the potential a home hospital approach could have for patients and the surrounding community.
"It opens up so many exciting possibilities -- it's exciting for patients because it gives them the opportunity to be in a familiar setting, and it's exciting for clinicians because we get to be with a patient in that person's own surroundings. As a community-minded hospital, this is a way for us to bring excellent care to our community,” Levine added.
This study, titled “Hospital-Level Care at Home for Acutely Ill Adults,” was published online in the Annals of Internal Medicine.