Hospital at Home, a concept created by investigators at the Johns Hopkins University Schools of Medicine and Public Health, has as its essential feature what the name suggests: patients with certain conditions serious enough to warrant hospital admission have the option of being treated by physicians and nurses in their homes. Presbyterian Healthcare Services (PHS), New Mexico's largest provider of care, adopted the program in 2008 because of the demands of serving an aging population with an increasing prevalence of chronic disease and a corresponding increase in use of health care services. A new study recently compared results in 323 geriatric PHS patients treated during 2009 and 2010 in the Hospital at Home program with those in a control group of 1,048 patients who were admitted to a PHS hospital.
The mean length of a Hospital at Home “stay” was 3.3 days, compared with 4.5 days among inpatients. Although PHS's five best-practice core quality metrics were met at rates of 91% to 99% among inpatients, all five metrics were met at a rate of 100% among patients treated in their homes. Patients cared for at home had lower rates of falls (0% versus 0.8%), and readmission to the hospital occurred at similar rates: 10.8% among Hospital at Home patients and 10.5% among inpatients. The rate of death during rehospitalization was also lower in the home-care group (0.93%) than in the patients originally treated in the hospital (3.4%). (Eight patients [2.5%] treated at home were transferred to the hospital, primarily because their conditions worsened.)
Overall patient satisfaction, too, was greater in patients treated in the Hospital at Home program than in control patients, and the mean cost, excluding physician cost, was 19% lower in patients cared for at home.—David Carter
Cryer L, et al. Health Aff (Millwood). 2012;31(6):1237–43