Hospital-Level Acute Care at Home via Direct Home Admission in Taiwan: A Non-randomized Controlled Pilot Trial Before National Implementation
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Yi-Chi Wang1, Jung-Yu Liao2, Fei-Ching Yang3
1Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Background:
Hospital-at-home (HaH) models are emerging globally, but evidence for community-initiated HaH within Taiwan's Integrated Home-Based Medical Care system remains limited.
Objective:
To evaluate the clinical outcomes, patient/caregiver experience, and feasibility of a HaH model centered on direct home admission (DHA), with a small proportion entering through an emergency department-passed pathway.
Design:
Prospective non-randomized controlled pilot trial conducted between October 2022 and July 2023.
Participants:
A total of 144 homebound older adults (83 HaH; 61 brick-and-mortar hospital) with acute infections requiring hospital-level treatment across 5 hospitals and 13 community clinics. Participants were generally frail, chronically ill, and functionally dependent.
Interventions:
The HaH group received interprofessional visits, intravenous pharmacotherapy, point-of-care diagnostics, and remote patient monitoring. The control group received standard inpatient care.
Main Measures:
Primary outcomes included remission/complete treatment, clinical escalation requiring hospital transfer, death during the treatment episode, and 30-day mortality. Secondary outcomes included length of stay (LOS), quality of life, and patient/caregiver satisfaction.
Key Results:
Remission/complete treatment was achieved in most patients in both groups (86.7% vs. 95.1%; p = 0.153). Mortality during the treatment episode was low (2.4% vs. 3.3%; p = 1.000). Nine HaH patients (10.8%) required clinical escalation. The HaH group had a significantly shorter LOS (9.72 vs. 11.85 days; p = 0.035) and reported significantly higher satisfaction, convenience, and willingness to choose the model again (p < 0.05).
Conclusions:
This pilot trial, the first to evaluate a DHA-based HaH model in Taiwan, provides preliminary evidence supporting the feasibility and acceptability of community-initiated hospital-level acute care at home (ACAH) for frail older adults. These findings support the integration of hospital-level acute care into Taiwan's existing home-care infrastructure and informed the subsequent development of the national ACAH program.
