Hospital at Home: Translation and Dissemination
Worcester, MA, United States
Hospital at Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients, Bruce Leff, MD; Lynda Burton, ScD; Scott Mader, MD; Bruce Naughton, MD; Jeffrey Burl, MD; Sharon Inouye, MD; William Greenough, MD; Susan Guido, RN; Christopher Langston, PhD; Kevin Frick, PhD; Donald Steinwachs, PhD; John Burton MD, Annals of Internal Medicine 2005; 143:798-808.
This journal article reports on a national demonstration and evaluation of the clinical feasibility and efficacy of providing hospital-level care in a patient’s homes for older patients who would typically be hospitalized. The study took place at 2 managed care organizations in Buffalo, NY, 1 in Worcester, MA, and a VA medical center in Portland, OR. To be eligible for the study, patients had to have one of 4 chronic conditions: congestive heart failure, chronic obstructive pulmonary disease, cellulitis, or community acquired pneumonia. They had to live within approximately 30 minutes of a hospital, and meet medical eligibility criteria. There were 349 eligible in the observation phase and 214 patients in the intervention phase. In the intervention phase, 84 were treated in Hospital at Home, 57 declined, 73 were not approached because they entered the hospital at hours the intervention was not operating. For those who received care at home, from 8 to 24 hours of continuous nursing care was given, daily visits from a physician, as well as 24 hour availability for emergency care. Patients received drugs, oxygen, laboratory tests, and other therapy in the home as needed. Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status and costs of care were measured. Hospital at Home met clinical process measures and quality standards at rates similar to those of the acute hospital. Length of stay was shorter, mean cost was lower, patients had a lower chance of developing delirium, requiring sedatives, or needing chemical restraints. Both patients and family members were more satisfied with care compared to those treated in the hospital.