- A new study found that the home hospital model can potentially improve care while reducing costs.
- The cost of care was nearly 40 percent lower.
- Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.
People check into the hospital expecting to get better, but there are risks — and some even wind up getting sicker.
You can face the danger of complications, like bleeding or infection. There are also the constant check-ins from nurses or physicians that can disrupt sleep.
And none of that includes the cost.
Additionally, when in a hospital, people are stuck in their hospital beds and many experience negative health impacts from this physical inactivity.
However, a pilot study by investigators at Brigham and Women’s Hospital in Boston finds that the home hospital model can potentially improve care while reducing costs. The findings were published in Annals of Internal Medicine today.
“Hospital at Home (HaH) as the name states, cares for hospital-eligible patients at home. Models vary, but generally patients seen in the emergency room that require hospital-level care are given the option of intensive care at home,” said Thomas Cornwell, MD, founder of Northwestern Medicine HomeCare Physicians and chief executive officer, Home Centered Care Institute (HCCI).
“To date, there has not yet been a randomized controlled trial of home hospital care performed in the U.S. other than our small pilot,” David Levine, MD, MPH, MA, the study’s corresponding author, told Healthline.
The results of Dr. Levine and team’s randomized controlled trial (RCT) can strengthen the case for home hospital care, showing that it reduces costs and readmissions while increasing physical activity compared with usual hospital care.
“We wanted to show with a very high level of evidence that home hospital care could be delivered to acutely ill adults with lower cost, better physical activity, high quality and safety, and excellent patient experience,” said Dr. Levine.
“In addition, we feel this gives all Americans the information they need to choose the care for themselves and their loved ones should they need hospitalization,” he said.
Levine and team enrolled 91 adult patients into the trial.
Each participant had been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with acute conditions that included infection, worsening heart failure, worsening chronic obstructive pulmonary disease (COPD), and asthma, that lived within 5 miles of the hospital.
They were randomized either to stay at the hospital for standard care or to receive care at home, including nurse and physician visits, intravenous (IV) medications, remote monitoring, video communication, and point-of-care testing.
Researchers measured the total direct cost of care, including costs for nonphysician labor, supplies, tests, and medications.
The findings indicate that patients receiving at-home care had total costs that were almost 40 percent lower than for patients treated conventionally.
“This study shows better outcomes for a lower cost in addition to a better use of resources. This is promising work and more and more attention is being paid to hospital care at home,” said Melissa O’Connor, PhD, MBA, RN, FGSA, and director, Geriatric Interest Group, Villanova University, M. Louise Fitzpatrick College of Nursing.
“However, further work is needed to determine the type of patient this best works for related to their severity of illness,” she said. “Do they need a caregiver? Do they need to be cognitively intact? What type of home environment is required?”
According to the study, those at home had fewer lab orders, less imaging (like X-ray and MRI), and had fewer consultations.
Levine and team also found that home hospital patients were less sedentary, and even had lower readmission rates within 30 days than patients admitted to hospital care.
“We also know that patients move more during a home hospitalization, which we believe goes a long way toward healing,” said Dr. Levine.
The study was actually stopped early on due to the strength of these findings.
“We didn’t build our home hospital study as a readmission reduction program, but one of the more surprising findings was how impactful home hospital care was on 30-day readmission,” said Levine. “Seven percent of home hospital patients, compared to 23 percent of traditional hospital patients, were readmitted at 30 days — nearly a 70 percent reduction!”
“Receiving care at home makes for a truly tailored experience,” emphasized Dr. Levine. “The answers to questions such as, ‘which medicines are you taking,’ or ‘what do you need help with during a typical day,’ and ‘what’s in your kitchen’ are easily discussed only when at home and have profound health and healing effects.”
But Dr. Cornwell remarked that Medicare and Medicaid won’t adequately cover the costs of hospital at home.
“There is not a separate fee-for-service payment for HaH. There are no specific codes for it. You would need to use the current house call codes which do not cover all the expense,” Dr. Cornwell said.
“It would be like charging a day in the hospital with an office visit code. Right now, those participating are systems that have at-risk contracts. Because they are on the hook for all medical costs, they benefit from the lower costs of HaH and the better outcomes and patient satisfaction,” he continued.
There are disadvantages to in-hospital care that can increase health risks, but a new clinical trial finds that providing hospital quality care in the home may reduce these risks and improve patient outcomes.
Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.
Although at-home care can reduce hospital costs and improve patient health, many health insurance providers, especially Medicare and Medicaid, still won’t cover the cost of home-based hospital care.