Home Hospital Pilot Lowers Acute Care Episode Costs 52%

Cost and utilization were lower and patients' physical activity was higher at home compared to usual care.

When it comes to patients' healing, few places can beat home, with its comforts and sense of familiarity. That's why, in recent years, hospitals have done what they can to make their campuses feel more homelike, with amenities such as private rooms, soundproofing, healing gardens, massage therapy services, and gourmet food.

But a small pilot study published in the Journal of General Internal Medicine has turned the idea of feeling at home at the hospital on its head. Instead, it brought the hospital to patients' homes and saved money in the process.

"We believe that people can heal from an acute illness in their home, and we want to show that this can be done in a high-quality, safe, cost-effective manner," the study's principal investigator, David Levine, MD, MPH, MA, an associate physician at Boston's Brigham and Women's Hospital and instructor in medicine at Harvard Medical School, told HealthLeaders Media via email.

"This is the first time a randomized controlled trial of home hospital has been performed," he noted.

A small pilot

The study, "Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial," included adults with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma who were admitted via the ED at either Brigham and Women's Hospital or Brigham and Women's Faulkner Hospital. The patients also had to live in the hospital's surrounding area.

Nine patients received their care at home, while 11 patients in a control group received the usual care in the traditional inpatient hospital. All patients were interviewed on admission, at discharge, and 30 days after discharge.

The patients who were cared for at home received a daily visit from an attending general internist and two daily visits from a home health registered nurse from Partners Healthcare at Home.

The home hospital model also included 24-hour physician coverage and electronic connectivity, including continuous monitoring, video, and texting.

Results

Patient experience was similar in both groups, but other results showed key differences.

"Cost and utilization were significantly less for those who were home hospitalized," Levine said. "For example, cost was about half for those at home compared to those in the traditional hospital. Those at home also had significantly more physical activity."

The results specifically were as follows:

• The median direct cost of the acute care episode for home patients was 52% lower for home patients than for control patients
• Home patients also had fewer laboratory orders (median per admission: 6 vs. 19) and less often received consultations (0% vs. 27%).
• "Home patients were more physically active (median minutes, 209 vs. 78), with a trend toward more sleep," the study said.
• No adverse events occurred among the home patients, whereas one occurred among the control patients.
• The median direct cost for the acute care plus 30-day postdischarge period for home patients was 67% lower, with trends toward less use of homecare services (22% vs. 55%) and fewer readmissions (11% vs. 36%).

"Our preliminary data suggest that home hospitalization reduces the cost of care," Levine said. "This provides a great signal that if implemented at scale, we could see a sizable reduction in the cost of hospitalization."

Next steps

Levine and his team are already advancing their research.

"We have nearly completed a larger randomized controlled trial very similar to this current publication. We look forward to sharing those findings in the coming months," he said. "We also will be presenting our qualitative findings shortly, which are a critical analysis of semi-structured interviews of the participants."

In addition, the researchers have surveyed the caregivers of the patients in the current publication, generating findings that Levine called "incredibly interesting," but not yet available. They will be published at a later date.

Key takeaways

There are several ways for hospitals to apply these findings to their own organizations. For example, there's already an opportunity for hospitals to set up a program such as the one studied.

"Home hospital programs need to be contextually designed, but are feasible in multiple settings," Levine said. "We are contacted all the time asking for help starting a home hospital program."

There are also takeaways from this research for more traditional inpatient care, care transitions, and care coordination.

"We use certain technologies that traditional hospital teams often wish they had," Levine said, referring to the monitoring technology used in the study, as well as point-of-care blood diagnostic technology.

"There is little reason that these more innovative technologies cannot be implemented in traditional inpatient settings," he added.

Despite home hospital's promise and potential, though, there's the perpetual problem of how to pay for it.

"Paying for home hospital is a major barrier in the United States right now," Levine said. "However, we are seeing that change with Medicare Advantage plans and ACOs, as well as commercial payers and even Medicare starting to consider paying for home hospitalization."