Pragmatic Evaluation of a New Hospital at Home Program

Hospital at Home (HaH) programs continue to proliferate in the United States. There are few evaluations of recently started HaH programs. We evaluated a recently started HaH program by conducting a retrospective cohort study comparing outcomes of those admitted to HaH versus those who stayed in the brick-and-mortar hospital. All participants were patients of a large southeastern health system who were invited to participate in HaH. We used electronic health record data for the evaluation, and propensity score matching to minimize effects from the non-random assignment to group. HaH is an attempt to replicate hospital care in the patient’s home. Patients are monitored remotely. They receive in-person visits by nurses, paramedics, and advanced practice providers under the supervision of a hospital medicine attending. Attending physicians conducted virtual visits daily. The primary outcome was hospital readmission at 30 days. We also evaluated mortality, length of stay, and falls. Six hundred and seventy-one patients were invited to HaH and had complete data. Median age was 76 years (IQR: 69-84 years). Fifty-two percent participated in HaH. Length of stay was similar for HaH versus non-HaH (median 5.0 vs 4.0 days, p = .067). Patients in HaH were readmitted within 30 days more frequently than non-HaH (11.9% vs 7.78%, propensity-score adjusted HR 1.78, 95% CI 1.09-2.91). Mortality at 90 days was similar for HaH versus non-HaH (10.6% vs 10.1%, propensity score adjusted HR 1.42 [95% CI, 0.68-2.97]). HaH has similar outcomes as brick-and-mortar, although this new HaH program had a higher risk of readmission.