Medically complex older patients who received care through a provider’s hospital-at-home program had “low” rates of mortality and readmission, according to recently published research data.
The national review of thousands of Medicare fee-for-service Part A claims was headed by researchers from Harvard Medical School and Mass General Brigham (MGB), the latter of which has been all-in on growing its own hospital-at-home program. MGB and other proponents of the care model have pointed to the reduced costs and warm reception from patients as reasons for the government to make permanent its Acute Hospital Care at Home Waiver, which is set to expire at the end of the year.
Researchers and MGB said the quality outcomes observed in the study — which persisted across patient demographics, disability status and dual-eligibility status — add to the case for Congress to extend coverage.
“In the last 40 years, there’s been a global movement to bring care back to the home,” David Michael Levine, M.D., clinical director for research and development for MGB’s Healthcare at Home program and the study’s corresponding author, said in a release from the health system. “We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
The final patient sample of Levine and colleagues’ study included 5,132 Medicare patients with a medical diagnosis indicating they received acute hospital care at home, representing 5,551 total admissions. Most were white (85%) and older than 75 years of age (62%), almost a fifth (18%) were disabled, and they had a mean household income of about $84,000.
The patients who had received the at-home care were “medically complex” (hierarchical condition category [HCC] score = 3.15), and often had diabetes (46%), chronic obstructive pulmonary disease (43%) and heart failure (43%). Their most common discharge diagnoses included heart failure, respiratory infection, sepsis, kidney/urinary tract infection and cellulitis.
Among this group, the researchers reported a 0.5% mortality rate during hospitalization and 3.2% mortality rate within 30 days of discharge. Just over 6% returned to the brick-and-mortar hospital for at least 24 hours during their acute hospital care at home (escalation rate), and within 30 days of discharge less than 3% required skilled-nursing facility use while almost 16% were readmitted.
Levine said that based on this study and prior research, acute hospital care at home “appears quite safe and of high quality from decades of research — you live longer, get readmitted less often and have fewer adverse events.”
He also noted that working with patients in their living space makes it easier to give discharge instructions, or to spot any social determinants that could be affecting their condition.
“For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare,” he said.
The findings were limited to traditional Medicare patients and, due to the methodology related to coding, may not have caught all patients who received acute hospital care at home during the study window. The researchers also lacked a comparative arm of patients to gauge the modality against.
Still, the “preliminary” national data “suggest that [acute hospital care at home] is an important care model to manage acute illness, including among socially vulnerable and medically complex patients,” the researchers wrote. “These data should help inform ongoing policy deliberations.”