Hospital-Level Care at Home for Adults Living in Rural Settings: A Randomized Clinical Trial.

Area of Science:

• Healthcare Delivery Models
• Rural Health Services
• Comparative Effectiveness Research

Background:

• Home hospital programs offer hospital-level acute care at home, traditionally in urban settings.
• Feasibility and outcomes of home hospital care in rural areas, facing access challenges, remain largely unknown.
• Comparing home hospital care with traditional brick-and-mortar (BAM) hospital care is crucial for rural populations.

Purpose of the Study:

• To compare the effectiveness and outcomes of home hospital care versus traditional brick-and-mortar hospital care for rural residents.
• To evaluate differences in cost, readmission rates, patient activity, and patient experience between the two care models.

Main Methods:

• A randomized clinical trial conducted in 3 rural areas in the US and Canada from 2022-2023.
• Adult patients requiring hospital-level care for acute conditions were randomized to either home hospital or BAM hospital care.
• Outcomes measured included direct costs, 30-day readmissions, days at home, physical activity (accelerometer), patient experience (Picker Score), and Net Promoter Score.

Main Results:

• No significant differences were found in the adjusted mean cost of acute episodes or 30-day readmission rates between home and BAM hospital care.
• Patients receiving home hospital care demonstrated significantly improved physical activity, with less sedentary time and more daily steps.
• Home hospital care resulted in significantly better patient experiences, as indicated by higher Picker Experience Scores and Net Promoter Scores.

Conclusions:

• Home hospital care is a viable option in rural settings, offering comparable costs and readmission rates to traditional hospital care.
• Home hospital care significantly enhances patient physical activity and overall experience, improving quality of life during acute illness recovery.
• Late transfer of patients to home care may have attenuated potential benefits, suggesting optimization of intervention timing is needed.