Home Hospital Care Enhances Quality, Reduces Costs

While hospitals have made great strides over the last several years in improving the patient experience, a patient’s home can be a good place for them to get better faster, according to a new study.

There are more than 35 million hospital admissions in the United States each year, according to the American Hospital Association. The average length of stay is nearly five days.

The study, published in the Journal of General Internal Medicine, was conducted to determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. The study found that the use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. 

Levine

Lead study author David Michael Levine, MD, MPH, MA, clinician-investigator, at Brigham and Women's Hospital and Harvard Medical School, and colleagues, performed a randomized controlled trial, which means patients were selected by chance to either stay in the hospital (control group) or come home with the home hospital team (intervention group).

Nine acutely ill patients were randomized to home and 11 patients were randomized to usual care. Median direct cost of the acute care episode for home patients was 52% lower than for control patients, according to the study.

“During the care episode, home patients had fewer laboratory orders and less often received consultations,” the study authors wrote. “Home patients were more physically active, with a trend toward more sleep. No adverse events occurred in home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% lower, with trends toward less use of home-care services (22% vs. 55%) and fewer readmissions (11% vs. 36%). Patient experience was similar in both groups.”

Unique findings

“We found that home hospital care is less expensive than traditional in-hospital care,” says Levine. “Patients are more physically active at home and have excellent patient experience at home. We believe strongly that the home can be a unique place to advance healing. Moving hospital-level care to the home advances this cause.”     

Home hospital represents a potential cost savings to inpatient admission, likely without sacrificing quality, safety, or patient experience, according to Levine

“Our findings regarding physical activity are unique,” Levine says. “Patients took about 1,800 steps when at home versus only 160 steps when in the hospital. This is a novel system that has the potential to scale nationwide.”