Patient-centred outcomes and cost-effectiveness of a hospital-at-home service model for older adults

Introduction: Medical Home (MH) is a hospital-at-home (HaH) service model developed to deliver multidisciplinary acute medical care for patients in their homes. This study evaluated the patient-centred outcomes and cost-effectiveness of the MH service compared with usual care (UC). Method: This quasi-experimental study involved 250 patients recruited from July 2021 to May 2023. Data on costs, healthcare resource utilisation, and patient-centred outcomes were collected at index admission, discharge, and 90 days post-discharge. Regression analyses were employed to estimate the incremental differences in patient-centred outcomes and net monetary benefit (NMB) between MH and UC groups, while adjusting for confounders. A probabilistic sensitivity analysis (PSA) was conducted to evaluate the uncertainty surrounding the data inputs for cost-effectiveness analysis. Subgroups excluding U-turn patients (i.e. patients admitted to the hospital before discharge from MH) and deaths were analysed for patient-centred and cost-effectiveness outcomes. Results: There was no statistically significant difference between the 2 groups in clinical, functional, and experience outcomes, except for length of stay and caregiver's overall experience in which the MH group had significantly better results compared with UC group. Compared to the UC group, the MH group showed a positive incremental NMB of SGD6895 (approximately USD5361; 95% confidence interval SGD1945-11,845) indicating the cost-effectiveness of the MH service. Results from the PSA showed that the MH group was costeffective across a range of willingness-to-pay thresholds. Subgroup analyses were consistent with the base case for patient-centred and cost-effectiveness outcomes. Conclusion: We conclude that an HaH care model like MH is a value-based and cost-effective alternative to admission to hospital for selected frail elderly patients, making it the preferred strategy.