People check into the hospital expecting to get better, but there are risks — and some even wind up getting sicker and face the danger of complications, like bleeding or infection. There are also 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. Many experienced 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 the Annals of Internal Medicine.
“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).
The first study of its kind
“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. “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.”
The cost of care was nearly 40 percent lower
Levine and team enrolled 91 adult patients into the trial. Each participant was 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. 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 those treated conventionally.
“Further work is needed to determine the type of patient this best works for related to their severity of illness,” said Melissa O’Connor, Ph.D., MBA, R.N., FGSA, and director, Geriatric Interest Group, Villanova University,
M. Louise Fitzpatrick College of Nursing.
Seventy percent lower readmission rate
According to the study, those at home had fewer lab orders, less imaging (like X-ray and MRI), and had fewer consultations. Levine and the team also found that home hospital patients were less sedentary and had lower readmission rates within 30 days than patients admitted to hospital care. “Seven percent of home hospital patients, compared to 23 percent of traditional hospital patients, were readmitted at 30 days, nearly a 70 percent reduction!” The study was actually stopped early on due to the strength of these findings.