'Hospital at home' beats inpatient care in readmission rates, patient experience

New York City-based Mount Sinai Health System researchers found hospital at home care provides shorter patient stays, lower hospital readmission rates and better patient experience when compared to inpatient care, a study published in JAMA Internal Medicine found.

Hospital at home provides acute hospital-level care in a patient's home as an alternative to traditional inpatient care. The service has not become widespread because there is no payment mechanism in fee-for-service Medicare.

Researchers at the Icahn School of Medicine at Mount Sinai studied patients between November 2014 and August 2017.

The researchers compared outcomes of patients who received hospital-at-home care followed by a 30-day post-acute period of home-based transitional care with hospital inpatients who did not receive hospital-at-home care. The researchers analyzed the experiences of 507 patients, including 295 hospital-at-home patients and 212 in a control group.

Five outcomes hospital-at-home participants, in contrast to the control group, experienced, according to the study:

1. Shorter length of stay (3.2 days vs. 5.5 days)
2. Lower hospital readmission rates (8.6 percent vs. 15.6 percent)
3. Lower emergency department visit rates (5.8 percent vs. 11.7 percent)
4. Fewer transfers to skilled nursing facilities (1.7 percent vs. 10.4 percent)
5. More likely to rate their medical care highly (67.8 percent vs. 45.6 percent)

"When you compare the patient treated in a hospital versus the home, the improvements are overwhelmingly positive from the point of view of clinical outcomes, patient safety, patient satisfaction, and cost savings," said Albert Siu, MD, chair emeritus of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine. "The availability of a payment mechanism is the one obstacle that stands in the way of widespread adoption of hospital-at-home care," Dr. Siu said.  

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1. Shorter length of stay (3.2 days vs. 5.5 days)
2. Lower hospital readmission rates (8.6 percent vs. 15.6 percent)
3. Lower emergency department visit rates (5.8 percent vs. 11.7 percent)
4. Fewer transfers to skilled nursing facilities (1.7 percent vs. 10.4 percent)
5. More likely to rate their medical care highly (67.8 percent vs. 45.6 percent)

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