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Hospital-At-Home

In 1995, Dr. John Burton of Johns Hopkins School of Medicine and Dr. Donna Regenstreif of the John A. Hartford Foundation envisioned Hospital at Home as an alternative for older adults needing acute care (Hospital at Home, 2012). They proposed providing medical and nursing care, as well as diagnostic and other services to patients in their own homes, instead of hospitalization in acute care facilities. Hospital at Home was in response to high healthcare costs, lengthy waits for available inpatient beds, safety concerns for hospitalized older adults, and recognition of the loss of function many older adults experience following hospitalization.

A team of geriatric specialists conducted a study to examine feasibility and outcomes (Leff et al., 1999). The pilot study recruited 17 patients age 65 or older who presented to the emergency department and were deemed to need hospitalization. Outcomes of the patients recruited for the study were comparable to those who were hospitalized in the acute care setting, and costs were 60% of those of the hospitalized group. Since that time, Hospital at Home has been successfully implemented around the country, in medical centers such as Brigham and Women’s Hospital, Massachusetts General Hospital, Mount Sinai Health System in New York and Presbyterian Healthcare Services in New Mexico as well as numerous veterans Administration Hospitals. Levine et al. (2020) recently conducted a randomized controlled trial to evaluate outcomes of home hospital versus usual hospital care. Ninety-one adults were assigned to home hospital or usual care in the hospital. Findings included lower costs, reduced readmissions and increased physical activity among patients hospitalized at home.

If you haven’t yet been involved in home hospitalizations, you may be in the near future. The recent surge in COVID-19 patients has led the Centers for Medicare and Medicaid Services (2021) to allow hospitals more flexibility in caring for patients who are not physically in the hospital. The Acute Hospital at Home Program requires that patients be evaluated daily by a registered nurse, either in person or remotely, and be visited twice daily by a registered nurse or trained paramedic. The decision was lauded by the American Hospital Association for its positive effect on the ability of hospitals to provide care to patients during the pandemic. This is another example of the lasting effect the pandemic will have on the United States healthcare system.

With warm regards,

Maureen Anthony


References

Centers for Medicare and Medicaid Services (November 25, 2020). CMS announces acute Hospital Care at Home program. https://www.aha.org/news/headline/2020-11-25-cms-announces-acute-hospital-care-home-program

Hospital at Home (2012). http://www.hospitalathome.org/about-us/history.php

Leff, B., Burton, L., Guido, S., Greenough, W. Steinwachs, D., & Burton, J. (1999). Home hospital program: A pilot study. Journal of the American Geriatrics Society, 47(6), 697-702.

Levine, D., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C., & Schnipper, J. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172 (2), 77-85.


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