Study finds hospital care at home safe and effective

TUESDAY, Jan. 9, 2024 (HealthDay News) — It’s an increasingly common approach: receiving hospital care at home.

A new study finds that people who are “hospitalized” at home tend to do at least as well as those who are hospitalized for treatment.

Patients who receive hospital care at home have lower mortality rates and are less likely to suffer setbacks that require a quick return to the emergency room, according to a new study published in the Annals of Internal Medicine.

“Home hospital care appears to be quite safe and of high quality: you live longer, you are readmitted to the hospital less frequently, and you have fewer adverse events,” said researcher David Michael Levine, clinical director of research and development at the Brigham Health Care Center at Massachusetts General Hospital. said the doctor. Plan from home.

“If people have the opportunity to give this to their mom, their dad, their brother, their sister… they should do it,” he added.

In 2020, the Centers for Medicare and Medicaid Services launched the Acute Hospital Home Care Waiver Program, making hospital-level home care available to Medicare patients as part of the federal government’s response to the coronavirus pandemic. -19.

Since then, thousands of patients at 300 Medicare-certified hospitals in 37 states have been treated at home instead of in the hospital.

The exemption will end in December unless Congress takes action, the researchers said in a supporting note.

“Home hospital care has been available around the world for decades,” Levine said. “This is an important moment in America where we could see a paradigm shift in the way we deliver a significant portion of our health care.”

The American Hospital Association says that thanks to advances in technology, hospitals can offer an unexpected range of services in the home.

People can receive complex X-ray images and heart scans at home, receive intravenous medications, obtain samples for lab tests, and receive meals and medications in bed.

For the study, Levine and his colleagues decided to investigate how patients across the country were receiving hospital care at home.

They analyzed Medicare claims from nearly 5,900 patients across the United States who received home care under the waiver program. The claims were submitted between July 2022 and June 2023.

Researchers found that patients treated at home were severely ill and had complex medical conditions.

About 43% have heart failure, another 43% have chronic obstructive pulmonary disease (COPD), 22% have cancer and 16% have dementia.

However, the researchers found a mortality rate of 0.5% among patients treated at home, with only about 6% needing to return to the hospital for treatment.

Patients also do well at home after home care.

Within 30 days of discharge, about 3% of people require admission to a nursing facility, another 3% die, and about 16% require readmission.

Those numbers are even better than clinical trials of Brigham Health’s home hospitalization pilot program, which launched in 2018 and 2020.

The trials found a 30-day readmission rate of 7% for patients hospitalized at home, compared with a 23% readmission rate for hospitalized patients, according to an American Hospital Association fact sheet. ). Only 7% of homebound patients had to be taken to the emergency room.

“We believe hospital care is better at home for several reasons,” Levine said.

When a hospital stay is over, people’s transition is easier, he said, “because we show patients how to take care of themselves at home, and they’re more likely to stay upright and do more activities.”

Managing a person’s medical care at home can also give healthcare professionals insight into their lives, including things that may be making their health worse.

“For example, we can talk about a patient’s diet in the kitchen or connect the patient to resources when we see the cupboards are empty,” Levine said.

The study also found that outcomes for home hospital care did not differ based on a person’s race or ethnicity or whether they had a disability.

“It’s reassuring that there are no clinically significant differences in outcomes in underserved populations because we know there are huge differences in outcomes with traditional inpatient care,” Levine said. “This shows that home hospitals do have access to diverse patients. and family groups.”

The findings were published on January 8.

More information

The American Hospital Association provides more information about home hospital care.

Source: Massachusetts Brigham General Hospital, press release, January 8, 2024

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