Outcomes Associated With Hospital at Home vs Traditional Inpatient Stay.

Area of Science:

• Health Services Research
• Comparative Effectiveness Research
• Geriatric Medicine

Background:

• Rising healthcare costs and strained inpatient capacity necessitate alternative acute care models.
• An aging population and workforce shortages exacerbate challenges in traditional hospital settings.

Purpose of the Study:

• To compare the outcomes of Hospital at Home (HaH) care versus traditional inpatient hospital admissions.
• To assess facility-level variations in the utilization of HaH services.

Main Methods:

• A retrospective, propensity score-matched study analyzed Medicare fee-for-service beneficiaries (≥65 years) admitted between 2021-2022.
• Compared outcomes including in-hospital mortality, 30-day readmissions, and 30-day emergency department visits between HaH and inpatient groups.
• Utilized conditional logistic regression and log-transformed linear regression for outcome analysis.

Main Results:

• HaH admissions (n=4174) showed significantly lower in-hospital mortality (0.4% vs 3.6%) and 30-day ED use (8.8% vs 10.0%) compared to traditional admissions (n=11697).
• No significant difference was observed in 30-day hospital readmissions between HaH and inpatient groups (11.7% vs 11.0%).
• Eleven hospitals accounted for approximately 50% of all HaH admissions among eligible facilities.

Conclusions:

• Hospital at Home care is associated with reduced mortality and emergency department utilization compared to traditional inpatient care for selected Medicare beneficiaries.
• HaH demonstrates potential as an effective alternative for acute care, maintaining similar or improved short-term outcomes.
• Further research is recommended to evaluate the implementation, equity, and long-term outcomes of HaH programs.