Hospital-at-home Reduces In-hospital Mortality, Ed Visits – But Not Readmissions

Hospital-at-home care has been presented as a more desirable and affordable alternative to long facility stays – and new research shows that the care model reduces in-hospital mortality and emergency department visits (ED) in the 30 days following discharge.

However, there was no significant difference in hospital admissions between hospital-at-home care and inpatient care, according to a new study published in JAMA Network Open. Hospital-at-home care did lead to modest reductions in total 30-day health care spend. 

“These findings support HaH as an approach that may maintain similar or better short-term outcomes among appropriately selected patients,” the study’s authors wrote. 

Researchers analyzed data from almost 16,000 Medicare fee-for-service beneficiaries at hospital-at-home waivered hospitals between Jan. 1, 2021, and Dec. 1, 2022, of whom approximately 4,200 received hospital-at-home services and almost 11,700 were admitted to traditional inpatient units.

Compared with traditional inpatient admissions, hospital-at-home patients had significantly lower odds of in-hospital mortality, researchers found. Among hospital-at-home admissions, 0.4% died in hospitals, compared to 3.6% of traditional inpatient admissions. ED utilization was also significantly lower, with 8.8% of hospital-at-home admissions visiting the ED, compared to 10% of inpatient admissions.

Researchers, however, did not see any difference in hospital readmissions. Readmission rates among hospital-at-home patients were 11.7%, while 11% of inpatient admissions were readmitted.

Hospital-at-home patients had lower odds of ICU escalation, with 3.5% needing ICU escalation compared with 7.9% of inpatient admissions.

The study’s findings that hospital-at-home has similar or better short-term clinical outcomes, as well as comparable costs to inpatient hospitalizations, likely reflect outcomes during the early implementation of hospital-at-home, where clinicians “enrolled clinically and operationally appropriate patients for the HaH mechanism,” the study’s authors wrote.

“At the hospital level, HaH admissions were highly concentrated within a subset of facilities, particularly in the US Northeast and South,” they continued. “In aggregate, these findings suggest that HaH can deliver safe, efficient, alternative acute care while alleviating pressures on health care systems. Second, they underscore the need to address practical and implementation challenges to broaden equitable access and obtain consistent clinical benefits across health systems.”

Some hospitals have avoided participating in the hospital-at-home waiver program due to uncertainty stemming from a series of short-term extensions. Earlier this year, the waiver program received a five-year extension, which was lauded by hospital-at-home players. 

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