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

TUESDAY, Jan. 9, 2024 (HealthDay News) — It’s an approach that’s becoming more widespread: getting hospital care at home.

A new study finds that people “hospitalized” at home do at least as much as if they were hospitalized for medical care.

According to a new study published in the Annals of Internal Medicine, patients who receive hospice care at home have a lower mortality rate and are less likely to suffer shocks that require a quick return to the emergency room.

“Hospital care at home appears to be very safe and of high quality: you live longer, you are readmitted less often and you have fewer adverse events,” researcher Dr. David Michael Levin, clinical director of research and development at Mass General Brigham Healthcare. At home program.

“If people have an opportunity to give this to their mom, their dad, their brother, their sister… they should,” he added.

Hospital-level home care became available to Medicare patients in 2020, when the Centers for Medicare and Medicaid Services launched the Acute Hospital Home Care Waiver Initiative as part of the federal government’s response to the Covid pandemic. -19.

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

The exemption will expire in December unless Congress acts, the researchers said in supporting notes.

“For decades, home hospital care has been offered around the world,” Levin said. “This is an important moment in the United States where we can see a paradigm shift in the way a significant portion of health care is delivered.”

According to the American Hospital Association, thanks to technological advances, hospitals can offer an unprecedentedly wide range of services at home.

People can get state-of-the-art X-ray images and heart scans at home, receive treatment with intravenous drugs, get samples for lab tests, and get food and medicine at their bedside.

In this study, Levin and his colleagues decided to examine how well patients across the country did in receiving hospital care at home.

They analyzed Medicare claims from about 5,900 patients across the United States who received home care under the waiver program. Claims were submitted between July 2022 to June 2023.

The researchers found that patients treated at home were significantly sicker, 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 a 0.5 percent death rate among patients treated at home, and only 6 percent had to return to the hospital for treatment, the results show.

Patients at home also did well after their home care ended.

Within 30 days of hospitalization from home, about 3 percent required admission to a nursing facility, another 3 percent died, and about 16 percent required readmission to the hospital.

Those numbers are even better than clinical trials of a home hospitalization pilot program launched by Brigham Health in 2018 and 2020.

(According to an American Hospital Association fact sheet, that trial found that the 30-day readmission rate for hospital-at-home patients was 7 percent versus 23 percent for inpatients.) Only 7% of home patients were rushed to the emergency room.

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

People have a smoother transition when they end their hospitalization, “as we show patients how to take care of themselves at home, where they’re more likely to stay upright and move more,” he said.

Managing a person’s medical treatment at home gives healthcare professionals insight into their lives, including things that may worsen their health.

“For example, we can talk about a patient’s diet in the kitchen or link the patient to resources when the cupboard is empty,” Levine said.

The study also found that home hospital care outcomes did not differ based on a person’s race or ethnicity, or whether they had a disability.

“It was reassuring to see that there were no clinically significant differences in outcomes between underserved populations, as we know there are large disparities in outcomes for traditional hospitalizations,” Levine said. “This suggests that a hospital at home can really reach a diverse group of patients and families.”

The findings were published on January 8.

More information

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

Source: Mass General Brigham, press release, January 8, 2024