Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.

BACKGROUND Acutely ill older persons often experience adverse events when cared for in the acute care hospital. OBJECTIVE To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home. DESIGN Prospective quasi-experiment. SETTING 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. PARTICIPANTS 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. INTERVENTION Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care. RESULTS Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001). LIMITATIONS Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences. CONCLUSIONS The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.