By February 28, 2018Commentary

It seems like an odd and risky concept–delivering hospital-level care in a patient’s home instead of actually institutionalizing them.  Hospitals often deliver excellent care, but they also are often sources of patient injuries, infections and other adverse events.  Trying to treat a patient at home makes sense in terms of avoiding the capital costs associated with a hospital and in terms of patient comfort of being in their house, but can it deliver safe, effective care and good outcomes.  A study published in the Journal of General Internal Medicine describes a pilot test of the concept in Boston.   (JGIM Article)   Adult patients who presented in the ER with infections, heart failure issues, COPD issues or asthma problems were randomized to being admitted or being part of a hospital-at-home pilot.  Certain patients were excluded from the care-at-home arm if they either had certain health conditions or were likely to need certain procedures or treatment.  Patients in the at-home arm received at least one daily visit from an internist and two from a home health registered nurse.  They had continuous monitoring, in-home radiology capability, and point-of-care blood lab work.  They could get oxygen therapy, respiratory therapies and infusions.  They had multiple communication methodologies with their care team.  Patients assigned to the hospital arm got usual hospital care.

Outcomes included costs and utilization, quality measures and patient interviews and assessments.  The study ended up being pretty small, with only 21 randomized patients.  The patients in each arm were demographically similar and had similar health status.  The median direct cost for the at-home patients was 52% lower than for those in the hospital.  The care period was about 3 days for each arm.  At-home patients had fewer lab tests and fewer consultations.  Costs in the 30-day post-acute episode were 67% lower for the at-home patients, with fewer readmissions.  No adverse safety events were reported for the at-home group.  Pain scores were similar.  Home patients had more minutes of physical activity per day and tended to have more mobility and better sleep.  Both sets of patients had high and equivalent patient satisfaction scores.  While very small, the pilot suggests that at-home acute care is possible and can save money while preserving or even improving outcomes.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at

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