Hospital-Level Care at Home for Acutely Ill Adults
| Autor: | Jeffrey L. Schnipper, Kei Ouchi, Kimberly Burke, Charles T. Pu, Agustina Saenz, Mary Paz, Keren Diamond, David M. Levine, Bonnie B. Blanchfield |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Cost Control MEDLINE Hospitals Community Population health Patient Readmission 01 natural sciences law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Acute care Patient experience Health care Internal Medicine Humans Medicine 030212 general & internal medicine 0101 mathematics Aged Aged 80 and over Academic Medical Centers business.industry 010102 general mathematics General Medicine Emergency department Home Care Services United States Community hospital Hospitalization Acute Disease Emergency medicine Costs and Cost Analysis Female Emergency Service Hospital business |
| Zdroj: | Annals of Internal Medicine. 172:77 |
| ISSN: | 0003-4819 |
| Popis: | Background Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking. Objective To compare outcomes of home hospital versus usual hospital care for patients requiring admission. Design Randomized controlled trial. (ClinicalTrials.gov: NCT03203759). Setting Academic medical center and community hospital. Patients 91 adults (43 home and 48 control) admitted via the emergency department with selected acute conditions. Intervention Acute care at home, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. Measurements The primary outcome was the total direct cost of the acute care episode (sum of costs for nonphysician labor, supplies, medications, and diagnostic tests). Secondary outcomes included health care use and physical activity during the acute care episode and at 30 days. Results The adjusted mean cost of the acute care episode was 38% (95% CI, 24% to 49%) lower for home patients than control patients. Compared with usual care patients, home patients had fewer laboratory orders (median per admission, 3 vs. 15), imaging studies (median, 14% vs. 44%), and consultations (median, 2% vs. 31%). Home patients spent a smaller proportion of the day sedentary (median, 12% vs. 23%) or lying down (median, 18% vs. 55%) and were readmitted less frequently within 30 days (7% vs. 23%). Limitation The study involved 2 sites, a small number of home physicians, and a small sample of highly selected patients (with a 63% refusal rate among potentially eligible patients); these factors may limit generalizability. Conclusion Substitutive home hospitalization reduced cost, health care use, and readmissions while increasing physical activity compared with usual hospital care. Primary funding source Partners HealthCare Center for Population Health and internal departmental funds. |
| Databáze: | OpenAIRE |
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