Remote vs In-home Physician Visits for Hospital-Level Care at Home: A Randomized Clinical Trial.

Area of Science:

• Medical Care
• Health Services Research
• Digital Health

Background:

• Home hospital care offers acute care services at home, traditionally requiring daily in-person physician visits.
• This model's scalability may be limited by the need for frequent in-home physician assessments.
• The efficacy and safety of substituting remote physician visits for in-home visits remain largely unexamined.

Purpose of the Study:

• To compare the safety and effectiveness of remote versus in-home physician care within a home hospital setting.
• To evaluate adverse events, patient experience, and readmission rates between the two care models.

Main Methods:

• A randomized clinical trial involving 172 adult patients requiring hospital-level acute care at home.
• Patients were randomized to receive either remote physician care (daily video visits) or traditional in-home physician care.
• Outcomes included adverse events (falls, pressure injuries, delirium), patient experience scores, and 30-day readmission rates.

Main Results:

• Remote physician care was noninferior to in-home care regarding adverse events (6.8 vs 3.9 per 100 patients) and patient experience.
• While remote care demonstrated noninferiority, 19% of patients in this group required additional in-home physician visits.
• 30-day readmission rates showed inconclusive differences between the groups.

Conclusions:

• Remote physician visits can be a safe and effective alternative to daily in-home visits in home hospital care, improving scalability.
• Patient experience was comparable between remote and in-home physician care models.
• Further research is needed to optimize the integration of remote care and determine when in-home physician visits remain essential.