Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely III older patients

Bruce Leff, Lynda Burton, Scott L. Mader, Bruce Naughton, Jeffrey Burl, Sharon K. Inouye, William B. Greenough, Susan Guido, Christopher Langston, Kevin D. Frick, Donald Steinwachs, John R. Burton

Research output: Contribution to journalArticle

Abstract

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. Design: Prospective quasi-experiment. Setting: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. Participants: 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. Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. Measurements: 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 vs. $7480) (P <0.001). Limitations: 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.

Original languageEnglish (US)
JournalAnnals of Internal Medicine
Volume143
Issue number11
StatePublished - Dec 6 2005

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Home Care Services
Medicare Part C
Independent Living
Costs and Cost Analysis
United States Department of Veterans Affairs
Process Assessment (Health Care)
Cellulitis
Selection Bias
Managed Care Programs
Standard of Care
Medicare

ASJC Scopus subject areas

  • Medicine(all)

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Hospital at home : Feasibility and outcomes of a program to provide hospital-level care at home for acutely III older patients. / Leff, Bruce; Burton, Lynda; Mader, Scott L.; Naughton, Bruce; Burl, Jeffrey; Inouye, Sharon K.; Greenough, William B.; Guido, Susan; Langston, Christopher; Frick, Kevin D.; Steinwachs, Donald; Burton, John R.

In: Annals of Internal Medicine, Vol. 143, No. 11, 06.12.2005.

Research output: Contribution to journalArticle

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abstract = "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. Design: Prospective quasi-experiment. Setting: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. Participants: 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. Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. Measurements: 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 vs. $7480) (P <0.001). Limitations: 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.",
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AU - Leff, Bruce

AU - Burton, Lynda

AU - Mader, Scott L.

AU - Naughton, Bruce

AU - Burl, Jeffrey

AU - Inouye, Sharon K.

AU - Greenough, William B.

AU - Guido, Susan

AU - Langston, Christopher

AU - Frick, Kevin D.

AU - Steinwachs, Donald

AU - Burton, John R.

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