Some hospitals are making house calls these days as they experiment with delivery of high-intensity care in people’s homes. Taking the hospital out of hospitalization might be safer and less expensive than conventional inpatient care. A study published in the Journal of General Internal Medicine supplies some supporting evidence for in-home hospitalization.
Right off the bat, the limitations of this study should be noted. Nine patients were randomly assigned to home care; 11 were assigned to hospital care. That’s on the tiny side of a small sample size as the researchers at Brigham and Women’s Hospital at Boston readily admit.
They argue, however, that the study was designed as a pilot, and that even with the small sample size “we were able to detect statistically significant differences in our primary outcome and several secondary outcomes because of the large effect sizes.”
Some of the differences they mentioned in the abstract stand out. Median direct costs of the home patients were half that (52% lower) of the control patients who received conventional hospital care. The home patients were more physically active (209 minutes per day vs. 78 minutes) and had fewer lab tests ordered (6 per “admission” vs. 19). If the 30-day post-discharge period is included with the acute care, then direct costs were 67% less for the home hospital patients.
David M. Levine, MD, the study’s corresponding author, commented in a press release that “we haven’t dramatically changed the way we’ve taken care of acutely ill patients in this country for almost a century. 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.”
The term “home hospital” is still evolving. The version used in this study involved one daily visit from a doctor, and at least two daily visits from a nurse. Home hospital patients could be provided oxygen, respiratory therapy (such as a nebulizer), intravenous medications, point-of-care diagnostics, and in-home radiology.
The doctor was available 24 hours a day for urgent care. “Criteria for discharge were, by design, left to the discretion of the home hospital attending [physician],” the authors wrote. “We mandated no treatment pathways or algorithms. Follow-up after discharge was by design no different than usual care.”