Clinical

Hospital-level care at home for acutely ill adults may be as safe as inpatient care


 

Background: Providing hospital-level care at home for select patients has proven to reduce health care cost, usage, and readmission rates, while maintaining quality and safety in other developed countries but few studies exist in the United States.

Dr. Brian Persaud

Study design: Randomized, controlled, unblinded, parallel-design trial.

Setting: Home hospital care versus inpatient care at two Boston academic hospitals, during June 2017–January 2018.

Synopsis: The study enrolled 91 adult patients from the emergency department who were deemed appropriate for non-ICU admission for treatment of prespecified diagnoses (i.e., COPD exacerbation, heart failure exacerbation, etc.). Participants were randomized to usual inpatient care or home hospital care. All home hospital patients received daily internist visits, twice-daily nursing visits, home access to additional services (physical/occupational therapy, social work, etc.), oxygen, IV medications, labs, radiology, and continuous monitoring. The authors found that home hospital care resulted in a lower total cost (P < .001), lower use of imaging and labs, and lower 30-day readmission rate, without appreciable differences in quality or safety between the two groups. Given that the study was performed at only two academic hospitals, it is unclear if these findings can be generalized to other health systems.

Bottom line: For the care of select illnesses, hospital-level care at home may be cheaper, may be just as safe, and reduced readmission rates when compared with inpatient care.

Citation: Levine D et al. Hospital-level care at home for acutely ill adults. Ann Intern Med. 2020;172:77-85.

Dr. Persaud is a hospitalist, Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

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