Evaluation of a hospital-in-home program implemented among veterans

To examine the outcomes (ie, costs, hospitalizations, and mortality) associated with a Hospital-in-Home (HIH) program implemented in 2010 by the Veterans Affairs (VA) Pacific Islands Healthcare System in Honolulu, Hawaii.

Retrospective cohort study.

We obtained medical information for veterans who were enrolled in the HIH program in Honolulu, Hawaii, between 2010 and 2013. For purposes of comparison, we also gathered VA data to identify a cohort of hospitalized veterans in Honolulu who were eligible for, but not enrolled in, the HIH program. Using VA administrative data, we extracted a set of individual-level variables at baseline to account for the differences between program enrollees and comparators. In total, 99 HIH program enrollees and 322 unenrolled veterans were included. We identified 3 sets of outcome variables: total costs of care related to the index event (ie, HIH services for enrollees and hospitalizations for comparators), hospitalizations, and mortality after discharge from the index event. We used a propensity score-matching approach to examine the difference in related outcomes between enrollees and comparators.

The average medical cost was $5150 per person for veterans receiving HIH services, and $8339 per person for veterans receiving traditional inpatient services. The difference was statistically significant (P <.01). There was no statistically significant difference in mortality or hospitalization rates after the index event.

This study provides evidence of the potential benefits of a model that delivers acute care in patients' homes. Considering the emergence of accountable healthcare organizations, interest in broader implementation of such programs may be worthy of investigation.