New research published this month shows that the home hospital model excels at reducing costs and improving patient outcomes in rural communities.
The study, conducted by researchers at Massachusetts Brigham General Hospital, included 161 adult patients who required hospitalization for acute conditions, primarily heart failure, chronic obstructive pulmonary disease, asthma or infection. The patients were recruited from rural communities after seeking emergency care at Blessing Hospital in rural Illinois, Hazard Appalachian Regional Healthcare in rural Kentucky, and Wetaskiwin Hospital and Nursing Center in rural Alberta, Canada.
The research team divided this group of patients into two categories: 82 received care at a brick-and-mortar facility and 79 received care at home. Home care includes twice-daily in-home visits with nurses and caregivers, as well as daily virtual visits with a physician or advanced practice provider.
Overall, the researchers found no significant differences in total costs between patients who received care at home and those who were hospitalized. However, when patients went home early during their stay, costs dropped dramatically—among patients who moved to a home hospital program within three days, care ended up being 27% cheaper than traditional inpatient care.
Dr. David Levine, the study's lead researcher, noted that many patients were transferred late throughout their hospitalization, meaning they spent several days in the physical hospital and only a few at home.
“This diminishes the home hospital effect. However, when we examine the subset of patients who are transferred home in less than three days, we do see cost savings because these patients spend more time at home, which is a lower cost environment,” he explained.
As for safety results, they were comparable between the two groups, with similar 30-day readmission rates and no significant differences in adverse events.
Patients treated at home were also more physically active, taking an average of 700 more steps per day, and were significantly more satisfied with their care – nearly twice as likely as hospitalized patients, as measured by Net Promoter Score.
The technology used in this trial is also not particularly novel, which highlights the potential feasibility of scaling up these home care models.
“The technology we're using is similar to what was available in previous trials five to 10 years ago. But one caveat that I don't have data for is how different cellphone service is in these rural communities, and that's certainly a factor to consider,” Dr. Levine said.
He added that his research team at Massachusetts General Hospital is preparing several further analyzes of rural patient populations.
For example, he said the team is studying the role of home caregivers and taking a deeper look at physical activity among rural patients.
He added that health care providers need more research examining home hospital care that is not tied to a physical facility.
Photo: SDI Productions, Getty Images
