Dr. John Burton, of Johns Hopkins School of Medicine, and Dr. Donna Regenstreif of The John A Hartford Foundation conceived a new program to provide safe and effective hospital-level care in the home. A geriatric study team led by Dr. Bruce Leff developed medical eligibility criteria and the basic clinical model and designed the study and measurement methodology.


A 17-patient pilot trial showed that Hospital at Home® was feasible, safe, and cost effective.


A National Demonstration and Evaluation Study tested Hospital at Home in three Medicare managed care organizations and one Veterans Affairs medical center. Hospital at Home met disease-specific quality standards at rates similar to the acute hospital. The average patient length of stay was shorter, and overall costs were a third lower than an inpatient stay. Patients also had a lower chance of developing delirium, requiring sedatives, or needing chemical restraints. In addition, both patients and family members were more satisfied with care compared to those treated in the hospital, and family member stress was lower. Patients also regained their ability to do usual tasks more quickly.


Hospital at Home is in practice or is being developed at numerous sites throughout the country, including:

  • Presbyterian Health Services, Albuquerque, New Mexico
  • Veterans Affairs Medical Center, Boise, Idaho
  • Veterans Affairs Medical Center, Honolulu, Hawaii
  • Veterans Affairs Medical Center, New Orleans, Louisiana
  • Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • Veterans Affairs Medical Center, Portland, Oregon
  • Veterans Affairs Medical Center, Bend, Oregon


A public/private partnership tested a modified model of Hospital at Home, in which home-based care is provided by nurses, with physician consult via biometrically enhanced two-way telemedicine-video. The new model is also managed by a physician group, instead of a hospital.


Clinically Home was formed to develop and commercialize the telemedicine-based care model. The Hospital at Home team is a partner and clinical consultant to Clinically Home, while continuing to offer and consult on the traditional Hospital at Home model.


Funded by a CMS Innovation Center challenge grant, the Icahn School of Medicine at Mount Sinai, New York is currently testing Hospital at Home to inform a possible 30-day bundled payment model for fee-for-service Medicare. In addition, the John A. Hartford Foundation is funding a research evaluation of the study, and supporting development of technical assistance resources in anticipation of a successful demonstration.