Lessons from a large national "hospital at home" program.

BACKGROUND

Hospital at Home (HAH) is a potential solution to the increasing demand for hospital beds, but concerns remain about its scalability. This study examines safety, effectiveness, and patient satisfaction in a large-scale HAH program.

METHODS

This retrospective cohort study utilized data from Clalit Health Services (CHS). The study population included all patients participating in the HAH program during 2022 who were discharged with a primary diagnosis of pneumonia, congestive heart failure, urinary tract infection, or cellulitis. These individuals were matched with patients admitted to general medical wards, and logistic regression analysis was performed to evaluate the association between admission type and outcomes. The primary safety endpoint was all-cause mortality at 30 days, while the primary effectiveness endpoint was rehospitalization within 30 days. Patient experience was measured using a telephone questionnaire.

RESULTS

A total of 3,335 HAH patients were matched to 3,335 hospital patients. At 30 days, mortality was 192 (5.8%) for HAH patients and 305 (9.1%) for hospital patients, with an adjusted odds ratio of 0.6 (CI 0.49–0.73, P < 0.001). Readmissions at 30 days were 435 (13%) among HAH patients and 526 (16%) in hospital patients, adjusted OR 0.8 (CI 0.70–0.92, p = 0.002). 84% of patients indicated a preference for HAH over hospital admission for future care.

CONCLUSIONS

HAH can provide a safe and effective setting to treat patients who need hospital-level care, with high levels of patient satisfaction. HAH has the potential to provide a scalable solution for the ever-increasing demand for hospital beds. Trial registration The study was approved by the CHS (community) institutional ethics and data utilization committee (0169–21).