Hospital Care at Home Cuts Costs, Reduces Readmissions

By Reuters Staff

December 19, 2019

NEW YORK (Reuters Health) - Providing hospital care at home for acutely ill adults reduces healthcare costs and utilization, while lowering readmission rates, according to new findings.

"In this randomized controlled trial of acutely ill adults requiring hospital admission, home hospital care reduced cost, decreased health care use and 30-day readmissions, and improved physical activity compared with traditional hospital care without appreciable differences in quality, safety, or patient experience," Dr. David M. Levine of Brigham and Women's Hospital in Boston and colleagues write in the Annals of Internal Medicine,

Spain, Australia, and other developed countries provide home hospital care. Studies show that it can cut costs without compromising quality and safety, and may be preferable to patients.

However, there has been little U.S. research comparing hospital to home hospital care. Dr. Levine and his team conducted the first pilot randomized controlled trial comparing the two, publishing their results in 2018.

In the new trial, conducted at an academic medical center and a community hospital, 91 patients with prespecified medical conditions were block-randomized to receive standard hospital care or home hospital care.

Patients in the home-care group had at least one visit a day from the attending general internist and two per day from a home-health-registered nurse. These patients also had continuous monitoring with a skin patch, VitalConnect, that tracks vital signs, movement and falls. They could communicate with the hospital by phone or encrypted video or short message service.

The adjusted cost of treatment was 38% lower with home patients (P<0.001), who spent a mean 4.5 days in acute care compared to 3.8 days for the hospitalized control group.

Patients treated at home were less likely to undergo imaging tests (14% vs. 44%) and had a median of three lab orders compared to 15 orders for the hospitalized patients. Seven percent of the home-care group were readmitted within 30 days of discharge, versus 23% of the control group.

Safety events occurred for 9% of the home patients and 15% of the control patients. The home patients spent a median of 12% of the day sedentary, versus 23% of the control group. They also spent less time lying down (18% vs. 55% of the day).

Both groups had high levels of satisfaction with their care, and said that they would recommend their acute-care experience.

"Reimagining the best place to care for selected acutely ill adults holds enormous potential," Dr. Levine and his team write. "Further work is needed to better understand the conditions and illness severity of patients who could be successfully cared for at home; new technologies we might deploy; and more efficient workflows that may optimize home-based teams and allow for expansion, both on a small scale and at a regional or national level."

In an accompanying editorial, Dr. John B. Wong and Dr. Joshua T. Cohen of Tufts Medical Center in Boston note that there are many clinical and administrative challenges to implementing hospital care at home, including the lack of a payment model.

"Despite these concerns, studies overall suggest that home hospital improves the care experience and reduces complications and costs for a broad range of selected patients," they add. "It is one approach to addressing existing inefficiencies, fragmented care, and high costs in the United States." SOURCE: Annals of Internal Medicine, online December 16, 2019