5-year checkup shows ‘hospital at home’ healthy but siloed

Hospital-at-home inpatient care is no worse than its traditional counterpart at facilitating good clinical outcomes for reasonable overall costs. 

In fact “HaH” is sometimes considerably better on both those scores.

Researchers arrived at the conclusion after comparing records of around 4,200 HaH Medicare patients with those of 11,700 Medicare peers who received care in brick-and-mortar institutions. 

The investigators, all from the University of Iowa’s Carver College of Medicine or its College of Public Health, found HaH admissions correlated with significantly lower in-hospital mortality and emergency department use within 30 days of discharge. 

In addition, the team noted no significant difference in 30-day readmission rates between HaH and traditional cohorts. 

Lead study author Priyanka Vakkalanka, PhD, and colleagues had their work published May 5 in JAMA Network Open. 

One of their key observations was that index hospitalization costs were higher for HaH—yet lower post-discharge costs contributed to modest reductions in total 30-day healthcare spending.

This finding suggests the HaH model can yield economic advantages without compromising short-term clinical outcomes, the team states.

In aggregate, Vakkalanka and co-authors remark, the present study “suggests HaH can deliver safe, efficient, alternative acute care while alleviating pressures on healthcare systems.”

Promising results, challenging hurdles 

The authors surmise their HaH-affirming findings probably exhibit outcomes achieved early on in the hospital-at-home era. 

This began in November 2020, when CMS first recognized the hospital-at-home model as a way to help health systems manage the public health crisis of that time. 

The study period “reflects early U.S. experience under the CMS AHCAH waiver during and immediately after the COVID-19 public health emergency,” Vakkalanka and co-authors explain. “Program maturity and pandemic-era operational pressures may have influenced patient selection, implementation and outcomes.”

In any case, the salient stroke has been allowing Medicare-participating hospitals to receive inpatient-level payment rates for treating patients in their own homes. 

Further, the team notes, the HaH admissions that emerged for analysis were largely clustered within a subset of facilities located in two regions—the Northeast and the South.

Thus their findings “underscore the need to address practical and implementation challenges to broaden equitable access and obtain consistent clinical benefits across health systems.”

Uneven adoption at the health system level 

Vakkalanka et al. cite previous studies that arrived at similarly HaH-positive conclusions as well as prior research documenting persistent barriers to widespread adoption.

“HaH programs reduce the time spent in the hospital environment and may, therefore, decrease opportunities for hospital-associated complications,” they write. 

“Despite these advantages, national adoption of HaH is uneven, with limited use in rural settings and the highest adoption in larger academic health centers.”

The study is available in full for free. 

Recent and related: 6 things the hospital-at-home model needs to scale up nationally