Publications

Following is a list of publications related to the development of Hospital at Home, including a brief description of each article and link to the complete article or article abstract.

Health Care Provider Evaluation of a Substitutive Model of Hospital at Home.
To evaluate provider's perspective of Hospital at Home, researchers interviewed eleven physicians and 26 nurses employed in three Medicare-Advantage plans and one Veterans Administration medical center. The evaluation of substitutive Hospital at Home care was positive. Positive effects included quicker patient functional recovery, greater opportunities for patient teaching, and increased communication with family caregivers. The article seeks to isolate concepts that operate at the patient level, the provider level, and the study site level, to establish which commentary applies to the Hospital at Home program (rather than to features of the specific study sites in which Hospital at Home was tested, or of providers). Areas of agreement and discordance between physicians’ and nurses’ perspectives on Hospital at Home are also examined. Marsteller JA, Medical Care. 2009 Sep;47(9):979-85.

Substitutive Hospital at Home for Older Persons: Effects on Costs.  To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with certain diagnosis, the authors analyzed data from the Hospital at Home clinical trial of 455 patients.   Costs were analyzed across all patients, within each of four separate health systems, and by condition. Total costs seem to be lower when Hospital at Home care is available for patients with congestive heart failure or chronic obstructive pulmonary disease. Savings may be possible, particularly for care of conditions that typically use substantial laboratory tests and procedures in traditional acute settings.  Frick K, Burton L, Clark R, Mader S, Naughton B, Burl J, Greenough W, Steinwachs D, Leff B.  The American Journal of Managed Care 2009 Jan; 15(1): 49-56.  (For additional appendices to this article, click here.

Defining and Disseminating the Hospital-at-Home Model.  This editorial positions that the Hospital at Home model, along with related substitutive care models, is associated with reductions in mortality, along with other benefits.  The author reviews dissemination challenges, and highlights the resources required to properly implement the program.  The author suggests that Hospital at Home care may be most successful as one element in a portfolio of tools and models focused on keeping some patients out of the acute care environment.  Leff B. Canadian Medical Association Journal.  2009 January: 180(2)

Comparison of Stress Experienced by Family Members of Patients Treated in Hospital at Home With That of Those Receiving Traditional Acute Hospital Care.  To assess differences in the stress of patient families, family members of the 214 patients in the Hospital at Home study completed a questionnaire assessing whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.  Stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients, and HaH does not appear to shift the burden of care from hospital staff to family members.  Leff B, Burton L, Mader SL, Naughton B, Burl J, Koehn D, Clark R, Greenough WB 3rd, Guido S, Steinwachs D, Burton JR. Journal of American Geriatric Society 2008 Jan; 56(1):117-23. Epub 2007 Nov 2. PMID: 17979955

Satisfaction With Hospital at Home Care reports on differences in satisfaction with acute care between patients who received treatment in the Hospital at Home program and those who received usual acute hospital care. All 214 patients in the study (84 treated in Hospital at Home and 130 in the acute care hospital) completed a survey measuring nine domains of care for patients and eight domains of care for family members.  Hospital at Home care was found to be associated with greater satisfaction than acute hospital inpatient care for patients and their family members.  Leff B, Burton L, Mader S, Naughton B, Burl J, Clark R, Greenough WB 3rd, Guido S, Steinwachs D, Burton JR.  Journal of American Geriatric Society 2006 Sept; 54(9):1355-63.  PMID: 16970642

Hospital at Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients reports on a national demonstration and evaluation of Hospital at Home. The program was found to meet clinical process measures and quality standards at rates similar to the acute hospital. LOS was shorter, mean cost was lower, and patients had a lower chance of developing delirium, requiring sedatives, or needing chemical restraints. Both patients and family members were more satisfied with care compared to those treated in the hospital. Bruce Leff, MD et al, Annals of Internal Medicine 2005; 143:798-808.

Acute Care at Home. The Health and Cost Effects of Substituting Home Care for Inpatient Acute Care: a Review of the Evidence. Dr. Leff reviews a paper by Soderstrom, Tousignant and Kaufman (CMAJ 1999;160:1151-1155). which concluded that compared with hospital care, acute home care produces no significant difference in health outcomes, and effects on social and health system costs vary with the condition studied. Dr. Leff’s review points out the limitations of the study, particularly the importance of targeting an intervention to the appropriate patient population and the importance of distinguishing substitutive or admission avoidance models from early discharge models. Leff B. Journal of American Geriatrics Society 2001;49(8):1123-5.

Home Hospital Program: a Pilot Study, reports the findings of a 17-patient pilot study of Hospital at Home. The program was found to be safe, feasible, cost-effective and highly satisfactory to patients, family members, physicians and nurses. Based on the study results, Hospital At Home initiated planning for a national, multi-site demonstration. Leff B, Burton L, Guido S, Greenough WB, Steinwachs D, Burton JR. Journal of American Geriatrics Society 1999;47(6):697-702.

A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. Hospital at Home was hypothesized to reduce the incidence of delirium, but a rigorous ascertainment of delirium was necessary because this syndrome is often underreported. The methodology for ascertaining delirium is described in this article in the context of the intervention that was developed to reduce the incidence in the acute hospital setting. Inouye SK, Bogardus ST, Jr., Charpentier PA, et al. New England Journal of Medicine 1999; 340(9):669-76.

Acceptability to Patients of a Home Hospital. To assess patient and family interest in Hospital at Home, the authors interviewed 87 hospital-admitted patients with a primary diagnosis of pneumonia, congestive heart failure, of chronic obstructive pulmonary disease. The patients were provided a brief description of Hospital At Home and how it would work. A majority of patients agreed that treatment via Hospital At Home would be more comfortable and less likely to result in a hospital-acquired infection. About 75% would be willing to select this type of care if it was offered. Burton LC, et al. Journal of American Geriatrics Society 1998; 46:605-9.

Prospective Evaluation of Clinical Criteria to Select Older Persons with Acute Medical Illness for Care in a Hypothetical Home Hospital. As a first step in establishing Hospital at Home, the study team set criteria to select patients who needed hospitalization for common acute medical illnesses. The selection criteria were applied to patients to determine differences between those who would have been eligible for a Hospital at Home or not. Eligible patients experienced shorter lengths of stay, fewer procedures, fewer complications and fewer events that could be handled only in the acute hospital setting, suggesting that the criteria could be used to select appropriate patients for Hospital at Home. Leff B., et al. Journal of American Geriatrics Society 1997; 45(9):1066-73.

Acute Medical Care in the Home includes a brief history of acute medical care in the home in the U.S. and a review of a home hospital program in Israel, which provided in-home, physician-supervised, interdisciplinary medical care for patients with adequate informal caregiver support who “required” hospitalization. The Israeli program demonstrated that home hospital systems are feasible and can deliver care to a significant number of patients. Leff B, Burton JR. Journal of American Geriatrics Society 1996; 44(5):603

Decreased Hospital Utilization by Older Adults Attributable to a Home Hospitalization Program provides an evaluation of the cost effectiveness of a short-term home health care program for older adults, called Home Hospitalization (HH), compared with the alternative of regular ambulatory care with general or geriatric hospitalization. Stessman J. Journal of American Geriatrics Society 1996; 44(5): 591-8.