National data study demonstrates value of acute hospital care at home

Since the Centers for Medicare and Medicaid Services launched the acute hospital home health (AHCaH) waiver program in 2020, thousands of patients from 300 hospitals in 37 states have been treated at home. However, outcomes for these patients at the national level are poorly understood, and the exemption is set to end in December 2024 absent legislation from Congress.

A new study by researchers at Brigham General in Massachusetts analyzed AHCaH outcomes in a diverse group of patients across the United States. This study provides preliminary evidence to suggest that home hospital is an important care model for managing acute illness, including socially vulnerable and medically complex patients. There is. The results are published in the following research letter: Annual report of internal medicine.

“For hundreds of years, ever since hospitals were founded, we have been telling patients to go to the hospital for acute care. But in the last 40 years, we have been trying to bring healthcare back into the home. There was a global movement to do so.” Corresponding Author David Michael Levine, MD, MPH, MA, Clinical Director of Research and Development at Mass General Brigham’s Healthcare at Home.

“We want to do more to help policymakers and clinicians make informed decisions about waiver extensions and permanent approvals to expand opportunities for patients to receive care in the comfort of their own homes. We wanted to do this national analysis to get the data.”

Advances in healthcare technology have made it more possible than ever to provide patients with treatment options at home, without the need for an office or hospital visit. In addition, Levine and other researchers at the Massachusetts General Brigham will present data relevant to clinicians, patients, caregivers, and policy makers to inform decisions about acute hospital home care models. To this end, we are conducting a rigorous nationwide survey.

Using Medicare piecework Part A claims filed between July 1, 2022 and June 30, 2023, Levine et al. We investigated the clinical characteristics and outcomes of patients. We then studied whether these clinical characteristics differed between different demographic groups.

Among the study group, 54% of patients were female, 85.2% were Caucasian, 61.8% were 75 years of age or older, and 18.1% had a disability. Median household income was $83,932.

When the research team looked at the hospitalization status of all these patients, they found that the mortality rate was 0.5% and the escalation rate (return visit for at least 24 hours) was 6.2%. Furthermore, within 30 days after discharge, 2.6% of patients utilized skilled nursing facilities, 3.2% died, and 15.6% were readmitted.

“From decades of research, hospital care at home appears to be extremely safe and of high quality: people live longer, are readmitted to the hospital less often, and have fewer adverse events,” Levine said. “If people have the opportunity to give this to their mothers, fathers, brothers and sisters, they should do it.”

The patients in the study had medically complex conditions, including 42.5% heart failure, 43.3% chronic obstructive pulmonary disease, 22.1% cancer, and 16.1% dementia. The five most common discharge diagnoses were heart failure, respiratory infections (including COVID-19), sepsis, kidney/urinary tract infections, and cellulitis.

“There are many reasons why we think hospital-level care is better at home,” Levine says. “For one thing, because we teach patients how to take care of themselves at home, the discharge process is smoother and patients are more likely to sit upright and move more. .Furthermore, clinical teams are better equipped to educate and train.” “We act on the social determinants of health that we see in the home, for example, in the kitchen about what a patient eats.” We can talk and connect patients with resources when they see empty cupboards.”

Results were also stratified by race and ethnicity, dual eligibility status, and disability status for Black and Latino patients. Results were consistent across all groups.

“We know there are large disparities in outcomes in traditional hospitalization, so we are relieved to find that there are no clinically meaningful differences in outcomes among marginalized populations.” Levine said. “This suggests that home hospitals can indeed accommodate a diverse group of patients and families.”

Still, this finding is limited to observational data, and additional research is needed to compare the measured outcomes with those in brick-and-mortar hospitals. Levine’s team is also currently investigating home hospital care for patients in rural areas, which are underrepresented in the current study.

“For decades, home hospital care has been provided around the world,” Levine said. “This is a critical moment for the United States where we may see a paradigm shift in the way we deliver a significant portion of our health care.”