Getting hospital care at home is safe and effective, study finds

TUESDAY, Jan. 9, 2024 (HealthDay News) — It’s an increasingly common approach: receiving hospital care at home.

A new study shows that people “hospitalized” at home tend to do at least as well as if they were admitted to hospital for medical care.

Patients receiving hospital-based care at home have a low mortality rate and are less likely to suffer setbacks that require a quick return to the emergency room, according to a new study published in the Annals of Internal Medicine.

“Hospital care at home appears to be quite safe and high quality: you live longer, have fewer hospitalizations and have fewer side effects,” researcher Dr. David Michael Levine, clinical director of research and development at Mass General Brigham’s Healthcare. Program “At Home”.

“If people had the opportunity to give this to their mom, their dad, their brother, their sister… they should do it,” he added.

Hospital home care became available to Medicare patients in 2020 when the Centers for Medicare and Medicaid Services launched an initiative to phase out hospital home care as part of the federal government’s response to the COVID pandemic.

Since then, thousands of patients at 300 Medicare-certified hospitals in 37 states have been treated at home rather than in the hospital.

That exemption will end in December unless Congress acts, the researchers said in accompanying notes.

“Hospital-at-home care has been offered throughout the world for decades,” Levine said. “This is an important moment for the United States where we can see a paradigm shift in how we deliver much of our health care.”

Thanks to technological advances, hospitals can provide an unexpectedly wide range of services in the home, according to the American Hospital Association.

People can receive sophisticated X-rays and heart scans at home, receive intravenous drug treatment, obtain samples for laboratory tests, and receive meals and medications in bed.

In this study, Levine and his colleagues decided to examine how well patients across the country fared when receiving hospital care in their own homes.

They analyzed Medicare claims for nearly 5,900 patients in the United States who received home care under the waiver program. The claims were filed between July 2022 and June 2023.

The researchers found that the patients treated at home were quite sick people with medically complex conditions.

About 43 percent had heart failure, another 43 percent had chronic obstructive pulmonary disease (COPD), 22 percent had cancer and 16 percent had dementia.

However, the researchers found the death rate among patients treated at home was 0.5 percent, and only about 6 percent had to return to the hospital for treatment, the results show.

Patients who were at home also felt well after completing treatment at home.

Within 30 days of discharge from home hospitalization, about 3 percent had to be admitted to a nursing home, another 3 percent had died, and about 16 percent required hospital readmission.

These numbers are even better than clinical trials of Brigham Health’s 2018 and 2020 home hospitalization pilot program.

These studies found that the 30-day readmission rate for hospital-at-home patients was 7 percent versus 23 percent for hospitalized patients, according to the American Hospital Association. Only 7% of home patients had to be rushed to the emergency department.

“There are several reasons why we believe hospital care is better than home care,” Levine said.

People have an easier time going through the transition after hospitalization ends “because we show patients how to take care of themselves at home, where they are also more likely to stand up straight and move more,” he said.

Managing a person’s care at home also gives health care providers the opportunity to better understand their life, including what may be making their health worse.

“For example, we might talk about a patient’s diet in the kitchen or connect a patient to resources when we see cupboards are empty,” Levine said.

The study also found that hospital-at-home health outcomes did not differ based on a person’s race or ethnicity or whether they were disabled.

“It was encouraging to see that there were no clinically meaningful differences in outcomes among underserved populations because we know there are huge differences in outcomes from traditional hospitalization,” Levine said. “This suggests that hospital at home can truly reach a diverse group of patients and their families.”

The results were published on January 8.

More information

The American Hospital Association has more information about hospital home care.

SOURCE: Mass General Brigham, press release, January 8, 2024.