Hospital-level care at home can reduce overall care costs, healthcare use and readmissions while still providing quality care and improving the patient experience, according to a new study published in the Annals of Internal Medicine. The findings bolster the idea the idea acute care can be delivered outside traditional facilities and in lower-cost settings that are more beneficial to patients.
In fact, the hospital at home model saves 38% on an acute care episode compare to control patients in the study. Part of this savings came from lower healthcare use, with home patients receiving fewer laboratory orders, imaging studies and consultations.
Patient experience was also improved at home, with patients spending less time being sedentary compared to usual care patients––12% vs. 23% of the day––or lying down––18% vs. 55%. They were also readmitted less frequently within 30 days––7% compared to 23%.
Researchers from Brigham and Women's Hospital and Harvard Medical School conducted a randomized controlled trial, analyzing 91 patients––43 home and 48 control––admitted through the emergency department with selected acute conditions. The patients were recruited in the ED at Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital, an academic medical center and a community hospital, respectively.
Patients in the home group were given a model of home visits with 24-hour physician coverage, twice-daily nurse visits and home-based treatments.
Researchers made note of the lower readmission rate among patients who received care at home.
“Perhaps patients who receive acute care at home are less likely to develop ‘posthospital syndrome’ because they sleep better; eat better; walk more; and become less deconditioned, malnourished and sedated,” wrote first author David M. Levine, MD, MPH, MA, an instructor in medicine at Brigham and Women’s Hospital, et al.
The researchers sought out to strengthen existing research that shows hospital at home models cost less, maintain quality and safety and improve patient experience. The study was limited with a small number of patients analyzed. It was also primarily paid for by Partners HealthCare Center for Population Health and internal departmental funds.