7 things to know about first trial to test home hospital model

A pilot study at Boston-based Brigham and Women's Hospital is rethinking the best place for acutely ill adults to receive care, according to a study published in The Journal of General Internal Medicine.

The study represents the first randomized, controlled clinical trial to test the home hospital model in the U.S. and examined the model's impact on direct cost as well as utilization. 

"We haven't dramatically changed the way we've taken care of acutely ill patients in this country for almost a century," said David Levine, MD, lead study author. "There are a lot of unintended consequences of hospitalization. Being able to shift the site of care is a powerful way to change how we care for acutely ill patients and it hasn't been studied in the U.S. with intense rigor. That was the impetus for our project."

Funding for this project was provided by the Center for Population Health at Partners HealthCare and the BRIght Futures Prize through Brigham and Women's Hospital.

Here are seven things to know about the pilot study.

1. The study recruited 20 adult patients admitted to the emergency department at Brigham and Women's Hospital or Boston-based Brigham and Women's Faulkner Hospital. Patients who were eligible to participate included those with any infection or exacerbations of heart failure, chronic obstructive pulmonary disease or asthma.

2. Participants were also required to live in the hospital's surrounding area. Researchers randomly selected nine patients to receive care at home while 11 received typical care in a hospital setting.

3. An attending general internist visited patients who received care at home on a daily basis and a home health registered nurse visited these patients twice a day. The home hospital model offered 24-hour physician coverage as well as continuous monitoring, video and texting.

4. Researchers interviewed patients in both sections of the study on admission, at discharge and 30 days after discharge.

5. The team found the average direct cost for acute care episodes for home patients was up to half of the cost for patients who received care in the hospital.

6. Researchers found the home hospital model decreased ED utilization and improved patients' amount of physical activity without significantly altering patient safety, experience or care quality.

7. Dr. Levine is conducting a larger scale trial to demonstrate the pilot study's results in a larger patient group.

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