Hospital at home linked to lower ED visits, in-hospital mortality: study

The findings suggest hospital at home could serve as a safe alternative to inpatient care, researchers wrote. However, adoption is uneven, with most programs located in urban areas.

Article By: Emily Olsen

Blog Source From : https://www.healthcaredive.com/

Dive Brief:Providing hospital-level care in patients’ homes was linked to better clinical outcomes, suggesting hospital-at-home programs could serve as a safe and efficient alternative to traditional inpatient care, according to a study published this week in JAMA Network Open. Hospital at home was associated with decreased emergency department use within 30 days of discharge and lower in-hospital mortality, according to the research. But patients at hospital-at-home programs saw no significant difference in hospital readmissions within 30 days. Additionally, adoption of hospital at home across the country is uneven, with few rural facilities participating, researchers wrote. The findings “underscore the need to address practical and implementation challenges to broaden equitable access,” they said.

Dive Insight: Under the hospital-at-home model, patients receive acute care in their homes instead of traditional hospitals, supported by remote monitoring and visits by clinicians. Proponents argue hospital-at-home care can be cheaper and more comfortable for patients, while allowing providers to free up hospital beds for more severe cases.The use of hospital at home expanded during the COVID-19 pandemic, when the CMS launched the Acute Hospital Care At Home program in a bid to help providers manage capacity challenges during the public health emergency.Lawmakers extended the program, which allows approved hospitals to provide acute care in patients’ homes and receive reimbursement, through September 2030. The long-term extension could motivate more hospitals to set up their own programs, experts say. Plus, hospital at home could be a boon for some patient outcomes, according to the JAMA research, which studied data from Medicare beneficiaries at hospitals with 12 or more hospital-at-home admissions in 2021 and 2022. Compared with patients in traditional inpatient care, those in hospital-at-home programs were less likely to be escalated to intensive care and develop hospital-related complications, such as infections. The hospital-at-home group also saw “minor decreases” in total healthcare costs, though the duration of care was longer, according to the study. However, adoption of hospital at home varies across the country, suggesting some providers are struggling to implement the programs, researchers said. Among the 68 hospitals included in the study, 11 accounted for about half of all hospital-at-home admissions. All of those hospitals were located in urban areas, while hospital-at-home admissions were particularly concentrated in the Northeast and the South. Only one high-utilizer hospital was in the Midwest, while none were located in the West, the study found.Rural communities might particularly struggle to set up programs, due to worse access to high-speed internet, long travel distances and staffing constraints, researchers wrote.