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Home Hospital Pilot Lowers Acute Care Episode Costs 52%

By Alexandra Wilson Pecci  
   February 27, 2018

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.


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."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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