Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.
BACKGROUND
Acutely ill older persons often experience adverse events when cared for in the acute care hospital.


OBJECTIVE
To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home.


METHODS
Prospective quasi-experiment.


METHODS
3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center.


METHODS
455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.


METHODS
Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital.


METHODS
Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care.


RESULTS
Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001).


CONCLUSIONS
Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences.


CONCLUSIONS
The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.
Leff
Bruce
B
Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, and The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21224, USA. bleff@jhmi.edu
Burton
Lynda
L
Mader
Scott L
SL
Naughton
Bruce
B
Burl
Jeffrey
J
Inouye
Sharon K
SK
Greenough
William B
WB
Guido
Susan
S
Langston
Christopher
C
Frick
Kevin D
KD
Steinwachs
Donald
D
Burton
John R
JR
D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002481:Cellulitis / Q000150:complications / Q000628:therapy; D017714:Community-Acquired Infections / Q000150:complications / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000150:complications / Q000628:therapy; D015397:Program Evaluation; D011446:Prospective Studies; D015983:Selection Bias; D014481:United States