Home-based care proves promising, but congressional action still needed

With the acute hospital care at home waiver set to expire in December 2024, Boston-based Mass General Brigham conducted a study to shed light on the outcomes and potential benefits of the home-based care model, suggesting its importance for managing acute illnesses.

The study, published in the Annals of Internal Medicine, analyzed outcomes for 5,858 patients across the U.S. under the waiver between July 1, 2022, and June 30, 2023, revealing promising results, according to a Jan. 8 press release from the health system. 

With a mortality rate of 0.5% and a 6.2% escalation rate (returning to the hospital for at least 24 hours), home hospital care demonstrated safety and high quality. Moreover, within 30 days of discharge, 2.6% of patients used a skilled nursing facility, 3.2% died and 15.6% were readmitted.

The patient demographics included in the study were 54% female, 85.2% white, and 18.1% disabled. Notably, the researchers said the outcomes were consistent across different demographic groups, including Black and Latino race and ethnicity, dual-eligible status, and disability status.

However, the study was only based on observational data. 

David Levine, MD, clinical director for research and development at MGB Healthcare at Home, told Becker's that this study emphasizes that home hospital care, backed by decades of research, leads to longer life expectancy, reduced readmissions and fewer adverse events. The patients included in the study had medically complex conditions such as heart failure, chronic obstructive pulmonary disease, cancer and dementia, showcasing the broad applicability of this care model.

"This study, for the first time, demonstrates that home hospital programs can take care of highly complex, highly acutely ill patients," he said. "The second big takeaway from this study is that home hospitals are delivering equitable care across disability, across dual eligibility, and across race and ethnicity."

With the waiver set to expire soon, Dr. Levine said he hopes to get this data into the hands of policymakers so they can gain a picture of how this model is producing real and beneficial results. 

"For policymakers, the game was really to get this data in their hands so they could see the real impact home-based care has had so that they feel good about this kind of care model," he said. "They have such a big decision to make about this model in the next few months, this data could really prove meaningful in helping aid that decision." 

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