Mortality rates low for hospital-at-home patients, study finds

The study could support extending acute hospital care at home, researchers said. A pandemic-era waiver for the programs will expire at the end of the year.

Article By: Emily Olsen

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

Dive Brief:

• Medicare patients treated in acute hospital-at-home programs had low levels of mortality and rarely needed to return to facilities for care, according to a new study published in Annals of Internal Medicine. 
• Researchers found that 0.5% of patients in the study died while receiving acute care in their homes, while 6.2% had to go back to the hospital for at least 24 hours.
• The results could help make the case to continue supporting hospital-level care delivered at home, researchers said. A waiver that expanded the programs at the height of the COVID-19 pandemic is set to expire at the end of the year.

Dive Insight:

The CMS launched the Acute Hospital Care At Home program in 2020, looking to help facilities increase their capacity as they struggled to manage a surge of COVID-19 patients. Thousands of patients from 300 hospitals have been treated in their homes thanks to the waiver, according to the study.

Researchers analyzed clinical characteristics and outcomes from more than 5,800 patients who received care under the Acute Hospital Care at Home waiver, using traditional Medicare claims filed between July 2022 and June 2023. 

Most of the patients were older — more than 40% were at least 80 years old — and had complex medical conditions. About 43% had heart disease or chronic obstructive pulmonary disease, while around 22% were diagnosed with cancer. 

But patients experienced low rates of mortality while undergoing care in hospital-at-home programs, and findings were consistent across demographic groups that frequently suffer worse outcomes, like Black or Latino patients or those who were dually eligible for Medicare and Medicaid. 

Researchers also followed patients shortly after their home care programs ended. Within 30 days of discharge, 3.2% of patients died, 15.6% were readmitted and 2.6% went to a skilled nursing facility.

Hospital-level care at home could be beneficial because providers can show patients how to care for themselves in their homes once they are discharged, said corresponding author David Michael Levine, clinical director for research and development for Mass General Brigham’s Healthcare at Home. They are also more likely to be able to stand up and move around while at home compared with a hospital setting. 

“In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home. For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare,” Levine said in a statement. 

But more research is needed to compare home care with brick-and-mortar hospitals, the study’s authors said. Rural patients, who are at greater risk for poor health outcomes and frequently need to travel further for care, were also underrepresented in the study.