Format

Send to

Choose Destination
J Gen Intern Med. 2018 May;33(5):729-736. doi: 10.1007/s11606-018-4307-z. Epub 2018 Feb 6.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

Author information

1
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. dmlevine@bwh.harvard.edu.
2
Harvard Medical School, Boston, MA, USA. dmlevine@bwh.harvard.edu.
3
Harvard Medical School, Boston, MA, USA.
4
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
5
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
6
Partners HealthCare at Home, Waltham, MA, USA.
7
Partners Healthcare System Center for Population Health, Boston, MA, USA.
8
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA.

Abstract

BACKGROUND:

Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.

OBJECTIVE:

Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience.

DESIGN:

Randomized controlled trial.

PARTICIPANTS:

Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma.

INTERVENTION:

Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing.

MAIN MEASURES:

Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience.

KEY RESULTS:

Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p < 0.01) and less often received consultations (0% vs. 27%; p = 0.04). Home patients were more physically active (median minutes, 209 vs. 78; p < 0.01), with a trend toward more sleep. No adverse events occurred in home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p < 0.01) lower, with trends toward less use of home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups.

CONCLUSIONS:

The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

KEYWORDS:

home hospital; home-based care; hospital alternative; hospital at home

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center