title: Substitutive Hospital at Home for older persons: effects on costs.
abstract: OBJECTIVE
  To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, or cellulitis.
  
  
  METHODS
  Prospective nonrandomized clinical trial involving 455 community-dwelling older patients in 3 Medicare managed care health systems and at a Department of Veterans Affairs medical center.
  
  
  METHODS
  Costs were analyzed across all patients, within each of the separate health systems, and by condition. Generalized linear models controlling for confounders and using a log link and gamma family specification were used to make inferences about the statistical significance of cost differences. t Tests were used to make inferences regarding differences in follow-up utilization.
  
  
  RESULTS
  The costs of the Hospital at Home intervention were significantly lower than those of usual acute hospital care (mean [SD], $5081 [$4427] vs $7480 [$8113]; P <.001). Laboratory and procedure expenditures were lower across all study sites and at each site individually. There were minimal significant differences in health service utilization between the study groups during the 8 weeks after the index hospitalization. As-treated analysis results were consistent with Hospital at Home costs being lower.
  
  
  CONCLUSIONS
  Total costs seem to be lower when substitutive Hospital at Home care is available for patients with congestive heart failure or chronic obstructive pulmonary disease. This result may be related to the study-based requirement for continuous nursing input. Savings may be possible, particularly for care of conditions that typically use substantial laboratory tests and procedures in traditional acute settings.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. kfrick@jhsph.edu
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Burton
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clark
authors.forename: Scott I
authors.initials: SI
authors.lastname: Mader
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Naughton
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Burl
authors.forename: William B
authors.initials: WB
authors.lastname: Greenough
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D006299:Health Services for the Aged / Q000191:economics*; D018575:Home Care Services, Hospital-Based / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008329:Managed Care Programs / Q000191:economics; D006278:Medicare; D011446:Prospective Studies; D014481:United States