Hospital care at home: Better, cheaper, faster?

Date: January 21, 2020
Journal: Annals of Internal Medicine
Citation: Wong JB, Cohen JT. "Hospital care at home: Better, cheaper, faster?," Annals of Internal Medicine Editorial, January 21, 2020.

More than 20 years ago, the first randomized controlled trial comparing acute care at home versus treatment in an acute care hospital found no major outcome differences for 5 conditions, with most patients and caregivers preferring home hospital care (1). Recognition that hospitalization could result in iatrogenic complications and functional decline in older persons led to a multicenter, nonrandomized study comparing hospital care at home versus hospital admission for patients aged 65 years or older with community-acquired pneumonia, chronic heart failure, chronic obstructive pulmonary disease, or cellulitis (2). The study found that home hospital care met quality standards and resulted in shorter stays (3.2 vs. 4.9 days) and lower mean costs ($5081 vs. $7480). A systematic review and meta-analysis of 10 randomized controlled studies found similar outcomes—and notably a survival advantage at 6 months—with hospital care at home (3).

Robert Doherty's column headline in ACP Internist argues that “It‘s hospital prices, stupid” that make U.S. health care “unaffordable and unavailable for millions” (4). A randomized trial by Levine and colleagues (5) compared in-hospital care with potentially less expensive home hospital care and found that at-home care did indeed result in less health care use. It also conferred health benefits, including less sedentary time, fewer readmissions within 30 days, and 38% lower mean direct costs. The study's strengths include randomization (albeit unblinded and voluntary); explicit inclusion and exclusion criteria; advances in home hospital support, including respiratory therapies, infusion pumps, in-home radiology,...

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