Why Data Point to Hospital At-Home Care as Next Evolution of Clinical Medicine

For decades, high-acuity health care has been imagined through a traditional lens, largely delivered through brick-and-mortar health care facilities with specialized equipment and highly trained personnel. Until recently, there wasn’t much of an alternative.

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As the population collectively ages and chronic conditions are rising, high-quality care doesn’t necessarily need to happen within the walls of a hospital. Thanks to technological advances fueled by rising levels of investment in digital health ($15.3B in 2022), receiving high-quality, hospital-level care in your own home is feasible.

In many ways, COVID-19 was a catalyst for an increase in demand for home-based care. TeleHealth visits went from 1% of physician visits in February 2020 to 14%-17% of visits now. The pandemic catapulted the telemedicine industry forward, providing an incentive to overcome infrastructure challenges that prevented advancements in the past.

Suddenly, health systems were forced to solve those issues, and the whole country benefited as we implemented solutions rapidly. Virtual consultations became a viable option for both basic health care needs and higher-stakes visits in fields, such as cardiology and oncology.

But telemedicine alone can’t meet the need for every type of care, particularly acute care that’s delivered in hospital settings. That realization led the US Centers for Medicare and Medicaid Services, with the encouragement of the American Hospital Association (AHA), to expand their Hospital Without Walls program, which began early in the pandemic, to include the Acute Hospital Care At Home program.

Announced in November 2020, this policy change enabled care for 60 different acute conditions, including heart failure, pneumonia, and more. It offered significant flexibility for Medicare patients to receive reimbursable care from the safety and comfort of their homes.

Now, health systems are taking advantage of the opportunity to provide better options to their patients. As of March 2023, 277 hospitals as part of 123 health systems in 37 states, were recipients of a CMS waiver that enables such home-based hospital care to be provided.

Researchers have begun conducting studies on the impact of home-based acute care models to understand how they affect health outcomes, quality of life, and both patient and provider costs. So far, the results are quite promising.

Here are 5 findings that could prove key to the adoption of home-based care:

1. Comparable or superior clinical outcomes

A systematic review undertaken during the pandemic by researchers in Singapore evaluated results from several relevant studies. Those results demonstrated that hospital-at-home models of care deliver clinical outcomes that are comparable or superior to those achieved through inpatient treatment.

2. Higher patient satisfaction

An international group of researchers reviewed a selection of studies to investigate whether at-home care could limit hospital admission. Along the way, they made the significant finding that it also drastically improved patient satisfaction. In fact, according to the review, “For each trial reporting patient satisfaction, those assigned to receive hospital care at home reported significantly higher levels of satisfaction across a range of different medical conditions.”

3. Lower readmission rates

In another study on care outcomes, Harvard researchers sought to identify the advantages of home-based care and found a variety of benefits. One major takeaway from their study is that data suggest that readmission rates are lower when hospital-level care is provided in the home rather than in an academic medical center or community hospital.

4. Increased physical activity

The same Harvard study analyzed the outcomes resulting from home-based acute care versus typical care. It demonstrated that hospital-at-home patients tend to engage in more physical activity. By contrast, those receiving in-hospital care tend to spend more time lying down or being sedentary.

5. Reduced health care costs

The study also found that at-home care resulted in significantly lower costs. The findings note that, in addition to their improved outcomes and lower rates of readmission, “the adjusted mean cost of the acute care episode” was 38% lower than traditional care. Patients receiving care at home required fewer lab orders and imaging studies, among other expenses.

With initial data like these that demonstrate both significant care benefits and the cost-effective nature of at-home care, it’s easy to understand why we’re beginning to see health systems across the country bolstering their at-home services and preparing new programs.

For example, The Ohio State University Wexner Medical Center delivers inpatient hospital services to patients in their homes. Patients in hospital care at-home have a specialized care team that visits, and they receive remote monitoring devices connected to a wireless-enabled digital tablet for 24/7 communication access to their care team.

The Ohio State University Wexner Medical Center has partnered with Dispatch Health to provide teams that focus on this specialized at-home care. Additional services, such as medication administration, meals, and rehabilitation are also provided in the patient’s home as needed.

The widespread adoption of at-home care is exciting. Although initial data on improved outcomes and savings are promising, as more health systems begin to offer the program, it will be very important to continue gathering data and building continued evidence of the efficiency and efficacy of a hospital at home program. At the end of the day, for continued sustainability, we will need to demonstrate lower unit costs and comparable or better quality for the investment levels to continue.

With health systems undergoing a necessary reevaluation of how they allocate their funding into the future, initial data support the need for them to offer a hospital-at-home option for patients they serve.

About the Author

Rachit Thariani is chief administrative officer for Post-Acute and Home-Based Care at The Ohio State University Wexner Medical Center.

References

1. Leong MQ, Lim CW, Lai YF Comparison of Hospital-at-Home models: a systematic review of reviews Open 2021;11:e043285. doi: 10.1136/bmjopen-2020-043285

2. Shepperd S, Doll H, Angus RM, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ. 2009;180(2):175-182. doi:10.1503/CMAJ.081491

3. Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan 21;172(2):77-85. doi: 10.7326/M19-0600. Epub 2019 Dec 17. PMID: 31842232.

4. The Administration on Aging. 2020 Profile of Older Americans. Published May 2020. https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf Accessed March 25, 2023.