A new study reports that hospital at home (HaH) care provides a shorter length of stay; reductions in hospital readmissions, emergency department visits, and transfers to skilled nursing facilities; and, improved patient experience versus traditional inpatient care.

The study, which spans nearly three years, includes patients with the broadest set of admitting diagnoses ever to be researched, thus strengthening the evidence base for the hospital at home care. The study was published online in JAMA Internal Medicine.

Hospital At Home

Hospital at home provides acute hospital-level care in a patient's home as a substitute for traditional inpatient care. While HaH has been adopted in integrated health care systems and the Veterans Affairs health system, it has not been disseminated broadly due to the absence of a payment mechanism in fee-for-service Medicare.

Care followed by a 30-day post-acute period of home-based transitional care with a control group of hospital inpatients who were HaH-eligible but refused participation or were seen in an emergency department when a HaH admission could not be initiated. Seeking to scale the hospital at home program.

The experiences of 507 patients were analyzed in the study, including 295 HaH patients and 212 controls. HaH participants, in contrast to controls, experienced the following outcomes:

1. Shorter length of stay (3.2 days vs. 5.5 days)

2. Lower rates of hospital readmissions (8.6% vs. 15.6%)

3. Lower rates of emergency department visits (5.8% vs. 11.7%)

4. Fewer transfers to skilled nursing facilities (1.7% vs. 10.4%)

5. More likely to rate their medical care highly (67.8% vs. 45.6%)

ED Revisit

When you compare the patient treated in a hospital versus the home, the improvements are overwhelmingly positive from clinical outcomes, patient safety, patient satisfaction, and cost savings. Reasons for greater efficiencies include shorter lengths of stay when patients are treated at home, reduced hospital readmissions, lower rates of adverse events, and fewer emergency department(ED) revisit.

Treating patients at home is part of a much broader drive by Mount Sinai, a health system encompassing seven hospitals in Manhattan, to develop its hospitals into centers of care for the broader community. 

The hospital of the future must closely mirror the needs of its community. Knowing when a patient will be better off receiving hospital-level care at home is key. Innovative care models, like hospital at home, ensure patients get the same level of care at home and avoid costly and unnecessary hospitalization.

How Does Hospital at Home Work?

Hospital at home care provides hospital-level services for beneficiaries with selected acute illnesses who would otherwise be hospitalized. Typically, a patient is admitted while in the hospital, then sent home via ambulance, where a physician or nurse practitioner provides home-based acute care services. 

Nurse Care At Home

Nurses visit once or more a day to provide most of the care, and a physician or NP sees patients at least daily in person or via video call facilitated by the nurse. During this period, nurses and social workers provide self-management support and coordination of care with primary care clinicians, specialists, rehabilitation, and outpatient testing as needed.