The following published articles report on the development and testing of Hospital at Home®.
Costs For ‘Hospital At Home’ Patients Were 19 Percent Lower, With Equal Or Better Outcomes Compared To Similar Inpatients
This article summarizes the results of Presbyterian Healthcare Services' adaption of Hospital at Home. Patients have comparable or better clinical outcomes compared with similar inpatients, and higher satisfaction levels. This program also achieved savings of 19 percent over costs for similar inpatients. Savings mostly resulted from lower average length-of-stay and use of fewer lab and diagnostic tests compared with similar patients.
Successful Models of Comprehensive Care for Older Adults With Chronic Conditions
In this report prepared for the Institute of Medicine's Retooling for an Aging America report, Hospital at Home is featured as an important and effective model of care for an aging population. Boult C, Green AF, Boult LB, Pacala JT, Snyder C, Leff B. J Am Geriatr Soc. 2009 Dec; 57(12):2328-37.
Health Care Provider Evaluation of a Substitutive Model of Hospital at Home
To evaluate provider perspective of Hospital at Home, researchers interviewed 11 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. Marsteller JA, Medical Care. 2009 Sep; 47(9):979-85.
Hospital at Home
This paper reviews the key attributes of Hospital at Home and its potential for improving acute care for older adults. Cheng J, Montalto M, Leff B. Clin Geriatr Med. 2009 Feb; 25(1):79-91, vi. PMID: 19217494.
Comparison of Functional Outcomes Associated with Hospital at Home and Traditional Acute Hospital Care
Researchers compared differences in the functional outcomes experienced by Hospital at Home patients and traditional acute hospital patients who were part of the prospective nonrandomized clinical trial. Patients treated in HaH experienced modest improvements in performance scores, while those treated in the acute care hospital declined. A greater proportion of HaH patients improved in function and smaller proportions declined or had no change. Leff B, Burton L, Mader SL, Naughton B, Burl J, Greenough WB 3rd, Guido S, Steinwachs D. J Am Geriatr Soc. 2009 Feb; 57(2):273-8. Epub 2008 Dec 11. PMID: 19170781
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 diagnoses, the authors analyzed data from the Hospital at Home clinical trial of 455 patients. Total costs seem to be lower when Hospital at Home care is available for patients with congestive heart failure or chronic obstructive pulmonary disease (COPD). Savings may be possible, particularly for care of conditions that typically require 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.
Defining and Disseminating the Hospital-at-Home Model
This editorial's position is that Hospital at Home, along with related substitutive care models, is associated with reductions in mortality and 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 Jan; 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
Family members of the 214 patients in the Hospital at Home study assessed stressful situations in connection to the patient's 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
This study compares the satisfaction of patients who received treatment in the Hospital at Home program and those who received usual acute hospital care. All 214 study patients completed a survey measuring nine domains of care for patients and eight domains of care for family members. Hospital at Home care was 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
This paper 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. Length of stay 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
This paper reports the findings of a 17-patient pilot study of Hospital at Home. The program proved 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.
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, or 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 percent 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
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. Journal of American Geriatrics Society 1996; 44(5):603