Hospital-at-home programs refashion care for chronically ill patients with acute medical issues, testing traditional notions of how to treat people who become seriously ill. Only a handful of the initiatives exist. The concept is getting more attention with increased pressure from the national health overhaul to improve the quality of medical care and lower costs. Hospital-at-home programs do both, according to research led by the concept's pioneer, Bruce Leff, director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore.