Identifying Optimal Acute Care Comparators to Inform the Evaluation of an Advanced Care at Home Pilot Program

Area of Science:

• Health Services Research
• Quality Improvement Science
• Acute Care Delivery Models

Background:

• Hospital at Home (H@H) programs are increasingly common, delivering acute care in patient residences.
• Existing H@H literature lacks uniformity in program design, evaluation, and patient populations, hindering generalizable insights.
• Standardized evaluation methods are needed to assess H@H program effectiveness and guide future development.

Purpose of the Study:

• To develop and implement a quality improvement evaluation strategy for the Kaiser Permanente Advanced Care at Home (KPACAH) program.
• To establish a robust method for identifying comparable inpatient populations for outcome evaluation.
• To leverage electronic health record data, chart reviews, and patient surveys for comparative analysis.

Main Methods:

• A three-step recruitment workflow was designed for identifying comparator patients.
• Electronic health record filtering tools generated daily lists of potential comparators.
• Manual chart reviews and patient phone interviews confirmed eligibility and interest for comparator enrollment.

Main Results:

• The workflow successfully identified and enrolled 446 comparator patients within five months.
• Enrolled comparators demonstrated similar demographics, hospitalization reasons, comorbidity burden, and utilization to KPACAH patients.
• This demonstrates the feasibility of creating a comparable control group for H@H outcome evaluation.

Conclusions:

• The developed workflow shows promise for identifying similar inpatients in traditional hospital settings.
• This facilitates enhanced outcomes evaluations for Hospital at Home programs.
• The strategy aids in estimating potential enrollee volume for program expansion.