From Annals of Internal Medicine

Treating some patients at home rather than in the hospital cost less, decreased the use of medical services and led to fewer patients needing to be readmitted to the hospital over the following month.

If the practice was adopted widely, the approachcould transform how acute care is delivered in the United States, the researchers said.

Findings from the study, a randomized controlled trial, are published in Annals of Internal Medicine.

Traditional hospital care is the standard for acute illness in the United States, but inpatient care is expensive and has many drawbacks for patients, such as adverse events like infections, delayed access to care, lack of physical activity, and sleep deprivation.

The home hospital model aims to get the right care to patients in a timely, convenient, and cost-effective fashion, but high quality evidence of this model’s effectiveness is lacking.

Researchers from Harvard Medical School, Brigham and Women’s Hospital studied 91 acutely ill adults (43 home and 48 control) to determine how delivering hospital-level care in a patient’s home compared with usual care in the hospital in terms of cost, health care utilization, quality, and patient experience.

The home hospital patients received nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. In comparing outcomes, the researchers found that substitutive home care demonstrated reduced cost, utilization, and readmission; increased physical activity; and no appreciable difference in quality or safety versus traditional hospital care.

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0600
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3714