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January 8, 2020

'Hospital at home' can be effective—and save money, Brigham and Women's pilot shows

Daily Briefing

    New findings from a pilot at Brigham and Women's Hospital show home hospital care could potentially provide better quality care and cost less than traditional hospital care for patients with certain conditions. The findings were published last month in the Annals of Internal Medicine.

    4 steps to develop a successful Hospital at Home program

    About the study

    To determine whether home hospital care is up to par with traditional care, researchers at Brigham and Women's tested a "hospital at home" program among 91 patients who were initially admitted to the hospital by way of the ED.

    To be eligible for at-home care patients had to show a certain level of mobility as well as "low risk for clinical deterioration," according to David Levine, a physician at Brigham and Women's and lead author of the study. The program focused on patients with certain medical conditions, including asthma, heart failure, and emphysema. Patients without a firm diagnosis were automatically referred to inpatient care.

    Eligible patients were randomly assigned to either receive hospital-level care in their homes or at the hospital. Patients receiving home care had at least one visit from a doctor and two visits from a nurse daily. Patients could also receive assistance from home health aides, social workers, and physical therapists if needed.

    Patients' vitals were monitored using a skin patch that was connected to clinicians' smartphones. Blood tests and imaging were also performed in the patients' homes.

    At-home hospital care as good or 'better' than inpatient care, study suggests

    The researchers found that patients in the home hospital program were less likely to be readmitted to the hospital within 30 days of discharge, with 7% of home patients needing to be admitted compared to 23% of hospital patients.

    On average, the health care costs of home patients were 38% lower than hospital patients.  

    The study also found that the home patients underwent fewer lab tests, at an average of three lab tests per patient compared with 15 per patient among hospital patients. Home patients also spent a smaller portion of their day in a sedentary position.

    Are home hospital programs the future of care?

    Levine praised the results, adding that the study could help clinicians "reimagin[e]" hospital care.

    "This work cements the idea that, for the right patients, we can deliver hospital-level care outside of the four walls of the traditional hospital and provides more of the data we need to make home hospital care the standard of care in our country," he said. "[I]t's exciting for patients because it gives them the opportunity to be in a familiar setting, and it's exciting for clinicians because we get to be with a patient in that person's own surroundings."

    Other academic health systems in the United States, including Johns Hopkins and Mount Sinai, have launched similar hospital at home programs, but Brigham and Women's program is the first randomized trial of a home program in the country, Brigham and Women's said in a release.

    John Wong, a physician at Tufts University Medical Center and co-author of an editorial accompanying the study, said a next step is figuring out whether the Brigham and Women's program could be applied at smaller hospitals, adding that the logistics might be difficult to flesh out.

    Both Wong and Levine mentioned that payment would have to be deliberated as well, considering there is currently no payment model for insurers to reimburse hospitals for home hospital care.

    Still, Wong said, "[W]e should explore more opportunities to provide patients with the care they need, in the place they'd prefer to have it," he said (Norton, HealthDay/U.S. News & World Report, 12/16; Brigham and Women's release, 12/16).

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