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Home-First or Hospital-First? A Propensity Score-Weighted Retrospective Cohort Study
Stephanie Q Ko1, Guang Cheng2, Tze Yeong Teng3
1NUHS@Home, National University Health System, Singapore, Singapore; Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.
Objectives:
This study aimed to compare clinical and utilization outcomes between home-first and hospital-first models of care in the operation of a hospital-at-home (HaH) program.
Design:
This is a retrospective cohort study in which the primary outcome was a composite of oxygenation, intensive care unit admission, and all-cause mortality and the primary utilization outcome was length of stay (hospital and home bed days).
Settings And Participants:
The study sample included 1025 patients with COVID-19 admitted to an HaH program in Singapore from September 23, 2021, to February 29, 2022.
Methods:
Propensity score weighting and regression analysis were used to adjust for confounding between both groups.
Results:
There was no significant difference in the odds of occurrence of the primary outcome between the home-first and hospital-first groups (OR, 1.17; 95% CI, 0.44-3.10). Home-first patients had a shorter length of stay by an average of 2.02 (95% CI, 1.10-2.93) days with no statistically significant difference in clinical outcomes compared with hospital-first patients.
Conclusions And Implications:
Patients with COVID-19 suitable for HaH should be considered for direct admission to HaH without need for an initial hospital stay.
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