Lower costs and healthcare utilization with hospital care at home

Référence

Levine DM, Ouchi K, Blanchfield B, et al. Hospital-level care at home for acutely ill adults. Ann Intern Med 2020;172(2):77-85.

Sommaire

This study took place at an academic medical center and a community hospital in the United States. Eligible patients were adults who presented to the emergency department who required admission for one of the following conditions: infection, heart failure, chronic obstructive pulmonary disease, asthma, chronic kidney disease requiring diuresis, diabetic complications, acute gout, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular rate, anticoagulation needs, or patients at end-of-life desiring medical management only. Of the 248 eligible patients, 157 were excluded, primarily because the patient or family declined to be in the study. Using concealed allocation, the investigators randomized the remaining patients to home care (n = 43) or usual care in the hospital (n = 48). The home care patients received 1 daily visit from an internist and 2 daily visits from a nurse, with additional visits as needed 24 hours a day. Specialty consultation was accessed via telemedicine. Respiratory therapies, intravenous medications, radiology, and blood diagnostic tests could be provided at home, and other services such as physical and occupational therapy were available as needed. All patients had continuous vitals, telemetry, and monitoring for movement and falls via a skin patch device. Patients in the 2 groups were chronically ill, frail, and elderly (median age = 80 years in the home group and 72 years in hospital group). Overall, the adjusted mean cost of an acute care episode, which included the costs for nonphysician labor, supplies, medications, and diagnostic tests, was 38% lower in the home group (95% CI 24% - 49%; P < .001). Home patients had fewer imaging studies (14% vs 44%), laboratory tests (3 vs 15), and consultations (2% vs 31%). They spent less time each day sedentary (12% vs. 23%) or lying down (18% vs. 55%). "Length of stay" was slightly longer for home patients (4.5 days vs 3.8 days), but home patients were less likely to be re-admitted within 30 days (7% vs 23%). Both groups reported high satisfaction with their care.