Hospital-level care delivered at home reduced costs and healthcare resource use and improved physical activity for acutely ill patients without compromising quality of care, according to a study published in the Journal of General Internal Medicine.
David M. Levine, MD, MPH, from the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues conducted a pilot trial among adults admitted through the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma to determine whether in-home hospital care would reduce costs while maintaining quality, safety, and patient experience.
Patients were randomly assigned to receive either home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing, or usual hospital-based care. The primary outcome was direct cost of the acute care episode; secondary outcomes included healthcare use, 30-day cost, physical activity, and patient experience.
Nine patients received home care and 11 received usual care. The median direct cost of the acute care episode was 52% lower for home care patients than for control patients (P =.05). During the period of care, home care patients had fewer laboratory orders (6 vs 19; P <.01) and received fewer consultations (0% vs 27%; P =.04) than those who were hospitalized. Furthermore, home care patients were more physically active than hospitalized patients (median minutes, 209 vs 78; P <.01), with a trend toward more sleep. No adverse events occurred in home care patients, whereas 1 occurred in hospitalized patients. The 30-day postdischarge median direct cost for acute care was 67% lower for the home care patients than for hospitalized patients (P <.01). There was a trend toward less use of home care services among home care patients as compared with hospitalized patients (22% vs 55%; P =.08), and fewer readmissions (11% vs 36%; P =.32).
“This randomized controlled pilot…demonstrates improvements in cost, utilization, and physical activity while likely maintaining quality, safety, and experience, with more definitive results awaiting a larger trial,” the researchers concluded.
Levine DM, Ouchi K, Blanchfield B, et al. Hospital-level care at home for acutely ill adults: a pilot randomized controlled trial [published online February 6, 2018]. J Gen Intern Med. doi: 10.1007/s11606-018-4307-z