The Hospital at Home concept, in which patients who would be admitted from the emergency department are instead visited by doctors, nurses and therapists in their homes, is less expensive than traditional inpatient treatment and achieves better outcomes.
That's according to an article in NEJM Catalyst by Bruce Leff, M.D., a professor of medicine at the Johns Hopkins University School of Medicine. Early studies showed fewer complications and greater patient and family satisfaction, he wrote. More recently, a 2012 analysis found a 39 percent lower six-month mortality rate.
During Hospital at Home treatment, a nurse visits twice a day and a doctor at least once a day. A team is available around the clock in case of urgent issues. Technicians and therapists take tests and provide therapies. Treatment averages three days, Leff wrote.
Successful programs link to disease-management programs and to primary- and palliative care programs, he said. Hospital at Home "can be a versatile platform for creating an alternative to skilled-nursing-facility care after hospital discharge, a complement to early-discharge programs, and an option for post-surgical care," he wrote.
For Hospital at Home to work, provider partners and vendors must provide services in a timely manner when an admission is activated, he said. It also would help if patients could be admitted to the program 24/7, he added. The lack of payment mechanism in fee-for-service Medicare is probably the biggest obstacle, he said, but pilot research projects now underway could provide answers.
Hospital at Home is different than transitional care, which provides intensive clinical follow-up care in the home for 30 days following discharge to try to reduce readmissions. Medicare recently approved the first third-party transitional-care provider.
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