OBJECTIVE: To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, or cellulitis. STUDY DESIGN: Prospective nonrandomized clinical trial involving 455 community-dwelling older patients in 3 Medicare managed care health systems and at a Department of Veterans Affairs medical center. METHODS: Costs were analyzed across all patients, within each of the separate health systems, and by condition. Generalized linear models controlling for confounders and using a log link and gamma family specification were used to make inferences about the statistical significance of cost differences. t Tests were used to make inferences regarding differences in follow-up utilization. RESULTS: The costs of the Hospital at Home intervention were significantly lower than those of usual acute hospital care (mean [SD], $5081 [$4427] vs $7480 [$8113]; P <.001). Laboratory and procedure expenditures were lower across all study sites and at each site individually. There were minimal significant differences in health service utilization between the study groups during the 8 weeks after the index hospitalization. As-treated analysis results were consistent with Hospital at Home costs being lower. CONCLUSIONS: Total costs seem to be lower when substitutive Hospital at Home care is available for patients with congestive heart failure or chronic obstructive pulmonary disease. This result may be related to the study-based requirement for continuous nursing input. Savings may be possible, particularly for care of conditions that typically use substantial laboratory tests and procedures in traditional acute settings.
OBJECTIVE: To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, or cellulitis. STUDY DESIGN: Prospective nonrandomized clinical trial involving 455 community-dwelling older patients in 3 Medicare managed care health systems and at a Department of Veterans Affairs medical center. METHODS: Costs were analyzed across all patients, within each of the separate health systems, and by condition. Generalized linear models controlling for confounders and using a log link and gamma family specification were used to make inferences about the statistical significance of cost differences. t Tests were used to make inferences regarding differences in follow-up utilization. RESULTS: The costs of the Hospital at Home intervention were significantly lower than those of usual acute hospital care (mean [SD], $5081 [$4427] vs $7480 [$8113]; P <.001). Laboratory and procedure expenditures were lower across all study sites and at each site individually. There were minimal significant differences in health service utilization between the study groups during the 8 weeks after the index hospitalization. As-treated analysis results were consistent with Hospital at Home costs being lower. CONCLUSIONS: Total costs seem to be lower when substitutive Hospital at Home care is available for patients with congestive heart failure or chronic obstructive pulmonary disease. This result may be related to the study-based requirement for continuous nursing input. Savings may be possible, particularly for care of conditions that typically use substantial laboratory tests and procedures in traditional acute settings.
Authors: Nicholas T Bott; Clifford C Sheckter; Daniel Yang; Stephanie Peters; Brian Brady; Scooter Plowman; Soo Borson; Bruce Leff; Robert M Kaplan; Terry Platchek; Arnold Milstein Journal: Am J Geriatr Psychiatry Date: 2018-09-28 Impact factor: 4.105
Authors: Kushal T Kadakia; Celynne A Balatbat; Albert L Siu; I Glenn Cohen; Consuelo H Wilkins; Victor J Dzau; Anaeze C Offodile 2nd Journal: Milbank Q Date: 2022-09-23 Impact factor: 6.237
Authors: Pamela M Saenger; Katherine A Ornstein; Melissa M Garrido; Sara Lubetsky; Evan Bollens-Lund; Linda V DeCherrie; Bruce Leff; Albert L Siu; Alex D Federman Journal: J Am Geriatr Soc Date: 2022-02-25 Impact factor: 7.538
Authors: Cecile M A Utens; Lucas M A Goossens; Frank W J M Smeenk; Onno C P van Schayck; Walter van Litsenburg; Annet Janssen; Monique van Vliet; Wiel Seezink; Dirk R A J Demunck; Brigitte van de Pas; Peter J de Bruijn; Anouschka van der Pouw; Jeroen M A M Retera; Petra de Laat-Bierings; Loes van Eijsden; Maria Braken; Riet Eijsermans; Maureen P M H Rutten-van Mölken Journal: BMC Public Health Date: 2010-10-18 Impact factor: 3.295
Authors: Amy Stuck; Christopher Crowley; Tracy Martinez; Alan Wittgrove; Jesse J Brennan; Theodore C Chan; Edward M Castillo Journal: West J Emerg Med Date: 2017-05-15
Authors: Andrea M Collins; Odiri J Eneje; Carole A Hancock; Daniel G Wootton; Stephen B Gordon Journal: BMC Pulm Med Date: 2014-02-26 Impact factor: 3.317
Authors: Alyson L Huntley; Melanie Chalder; Ali R G Shaw; William Hollingworth; Chris Metcalfe; Jonathan Richard Benger; Sarah Purdy Journal: BMJ Open Date: 2017-08-01 Impact factor: 2.692