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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.
This article 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, Hospital at Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients Annals of Internal Medicine 2005; 143:798-808.
Dr. Leff reviewed 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. Acute Care at Home. The Health and Cost Effects of Substituting Home Care for Inpatient Acute Care: a Review of the Evidence Journal of American Geriatrics Society 2001;49(8):1123-5.
This article 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. Home Hospital Program: a Pilot Study Journal of American Geriatrics Society 1999;47(6):697-702.
Hospital at Home was hypothesized to reduce the incidence of delirium. 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. A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients New England Journal of Medicine 1999; 340(9):669-76.
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. Acceptability to Patients of a Home Hospital Journal of American Geriatrics Society 1998; 46:605-9.
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. Prospective Evaluation of Clinical Criteria to Select Older Persons with Acute Medical Illness for Care in a Hypothetical Home Hospital Journal of American Geriatrics Society 1997; 45(9):1066-73.
This article 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.. Acute Medical Care in the Home Journal of American Geriatrics Society 1996; 44(5):603
This article 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. Decreased Hospital Utilization by Older Adults Attributable to a Home Hospitalization Program Journal of American Geriatrics Society 1996; 44(5): 591-8.
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