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Abstract
Acutely ill older persons often experience adverse events when cared for in the acute
care hospital.
To assess the clinical feasibility and efficacy of providing acute hospital-level
care in a patient's home in a hospital at home.
Prospective quasi-experiment.
3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans
Administration medical center.
455 community-dwelling elderly patients who required admission to an acute care hospital
for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation
of chronic obstructive pulmonary disease, or cellulitis.
Treatment in a hospital-at-home model of care that substitutes for treatment in an
acute care hospital.
Clinical process measures, standards of care, clinical complications, satisfaction
with care, functional status, and costs of care.
Hospital-at-home care was feasible and efficacious in delivering hospital-level care
to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home
care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home
care. Although less procedurally oriented than acute hospital care, hospital-at-home
care met quality standards at rates similar to those of acute hospital care. On an
intention-to-treat basis, patients treated in hospital-at-home had a shorter length
of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also
had fewer complications. The mean cost was lower for hospital-at-home care than for
acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001).
Possible selection bias because of the quasi-experimental design and missing data,
modest sample size, and study site differences.
The hospital-at-home care model is feasible, safe, and efficacious for certain older
patients with selected acute medical illnesses who require acute hospital-level care.