David M Levine1, Kei Ouchi1, Bonnie Blanchfield1, Agustina Saenz1, Kimberly Burke2, Mary Paz2, Keren Diamond3, Charles T Pu4, Jeffrey L Schnipper1. 1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (D.M.L., K.O., B.B., A.S., J.L.S.). 2. Brigham and Women's Hospital, Boston, Massachusetts (K.B., M.P.). 3. Partners HealthCare at Home, Waltham, Massachusetts (K.D.). 4. Harvard Medical School, Massachusetts General Hospital, and Partners HealthCare System Center for Population Health, Boston, Massachusetts (C.T.P.).
Abstract
Background: Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking. Objective: To compare outcomes of home hospital versus usual hospital care for patients requiring admission. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT03203759). Setting: Academic medical center and community hospital. Patients: 91 adults (43 home and 48 control) admitted via the emergency department with selected acute conditions. Intervention: Acute care at home, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. Measurements: The primary outcome was the total direct cost of the acute care episode (sum of costs for nonphysician labor, supplies, medications, and diagnostic tests). Secondary outcomes included health care use and physical activity during the acute care episode and at 30 days. Results: The adjusted mean cost of the acute care episode was 38% (95% CI, 24% to 49%) lower for home patients than control patients. Compared with usual care patients, home patients had fewer laboratory orders (median per admission, 3 vs. 15), imaging studies (median, 14% vs. 44%), and consultations (median, 2% vs. 31%). Home patients spent a smaller proportion of the day sedentary (median, 12% vs. 23%) or lying down (median, 18% vs. 55%) and were readmitted less frequently within 30 days (7% vs. 23%). Limitation: The study involved 2 sites, a small number of home physicians, and a small sample of highly selected patients (with a 63% refusal rate among potentially eligible patients); these factors may limit generalizability. Conclusion: Substitutive home hospitalization reduced cost, health care use, and readmissions while increasing physical activity compared with usual hospital care. Primary Funding Source: Partners HealthCare Center for Population Health and internal departmental funds.
RCT Entities:
Background: Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking. Objective: To compare outcomes of home hospital versus usual hospital care for patients requiring admission. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT03203759). Setting: Academic medical center and community hospital. Patients: 91 adults (43 home and 48 control) admitted via the emergency department with selected acute conditions. Intervention: Acute care at home, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. Measurements: The primary outcome was the total direct cost of the acute care episode (sum of costs for nonphysician labor, supplies, medications, and diagnostic tests). Secondary outcomes included health care use and physical activity during the acute care episode and at 30 days. Results: The adjusted mean cost of the acute care episode was 38% (95% CI, 24% to 49%) lower for home patients than control patients. Compared with usual care patients, home patients had fewer laboratory orders (median per admission, 3 vs. 15), imaging studies (median, 14% vs. 44%), and consultations (median, 2% vs. 31%). Home patients spent a smaller proportion of the day sedentary (median, 12% vs. 23%) or lying down (median, 18% vs. 55%) and were readmitted less frequently within 30 days (7% vs. 23%). Limitation: The study involved 2 sites, a small number of home physicians, and a small sample of highly selected patients (with a 63% refusal rate among potentially eligible patients); these factors may limit generalizability. Conclusion: Substitutive home hospitalization reduced cost, health care use, and readmissions while increasing physical activity compared with usual hospital care. Primary Funding Source: Partners HealthCare Center for Population Health and internal departmental funds.
Authors: Sasha Shepperd; Chris Butler; Andrea Cradduck-Bamford; Graham Ellis; Alastair Gray; Anthony Hemsley; Pradeep Khanna; Peter Langhorne; Sam Mort; Scott Ramsay; Rebekah Schiff; David J Stott; Angela Wilkinson; Ly-Mee Yu; John Young Journal: Ann Intern Med Date: 2021-04-20 Impact factor: 25.391
Authors: Kevin Chen; Keval Desai; Soundari Sureshanand; Kerin Adelson; Jeremy I Schwartz; Cary P Gross; Sarwat I Chaudhry Journal: JCO Oncol Pract Date: 2021-01-08
Authors: Matthew R Augustine; Albert L Siu; Kenneth S Boockvar; Linda V DeCherrie; Bruce A Leff; Alex D Federman Journal: Home Healthc Now Date: 2021 Sep-Oct 01
Authors: Kathi Mooney; Karen Titchener; Benjamin Haaland; Lorinda A Coombs; Brock O'Neil; Richard Nelson; Jordan P McPherson; Anne C Kirchhoff; Anna C Beck; John H Ward Journal: J Clin Oncol Date: 2021-05-17 Impact factor: 50.717
Authors: Geneviève Arsenault-Lapierre; Mary Henein; Dina Gaid; Mélanie Le Berre; Genevieve Gore; Isabelle Vedel Journal: JAMA Netw Open Date: 2021-06-01
Authors: Shubing Cai; Orna Intrator; Caitlin Chan; Laurence Buxbaum; Mary Ann Haggerty; Ciaran S Phibbs; Edna Schwab; Bruce Kinosian Journal: JAMA Netw Open Date: 2021-06-01
Authors: Kei Ouchi; Shan Liu; Daniel Tonellato; Yonatan G Keschner; Maura Kennedy; David M Levine Journal: J Am Coll Emerg Physicians Open Date: 2021-07-21
Authors: Anand Srivastava; Xuan Cai; Rupal Mehta; Jungwha Lee; David I Chu; Katherine T Mills; Tariq Shafi; Jonathan J Taliercio; Jesse Y Hsu; Sarah J Schrauben; Milda R Saunders; Clarissa J Diamantidis; Chi-Yuan Hsu; Sushrut S Waikar; James P Lash; Tamara Isakova Journal: Kidney Int Rep Date: 2021-03-31