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'Hospital at Home’ cuts costs, maintains quality

Monday June 11, 2012
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Using a program that allows medical professionals to provide acute hospital-level care within a patient’s home, a health system reduced costs by almost 20% and provided equal or better outcomes compared with hospital inpatients, according to a study.

The program was developed by Johns Hopkins University researchers and implemented on an experimental basis by a health system in New Mexico.

"Hospital at Home is an excellent model of care that can be implemented in a practical way by health delivery systems across the country and can have dramatic positive clinical and economic outcomes for patients and systems," Bruce Leff, MD, who developed the Hospital at Home model, said in a news release.

"This program represents what healthcare reform is attempting to achieve; it’s a high-quality clinical program that provides patient-centric, individualized care while making the most effective and efficient use of the healthcare dollar."

The yearlong study involved 323 patients who were sick enough to require hospitalization, but who instead opted for care through the Hospital at Home program. Researchers compared those patients with 1,048 hospital inpatients. All Hospital at Home patients in the study met validated medical eligibility criteria to ensure patient safety and lived in a residence within a 25-mile radius of an ED run by Presbyterian Healthcare Services of Albuquerque, N.M.

Patients in both groups were elderly and mostly female and white. The most common diagnosis was pneumonia; other diagnoses included recurring heart failure, cellulitis, deep vein thrombosis, pulmonary embolism, urinary tract infection, nausea, vomiting and dehydration.

Physicians visited each patient daily for medical care, diagnosis and care plan coordination. Depending on the patient’s condition, nurses would visit once or twice daily to assess the patient and administer infusions and other medications, conduct routine lab tests, perform ordered care procedures, teach patients and families about managing their medical conditions and prepare them for eventual discharge and transition.

Among the study’s key findings was that Hospital at Home patients had slightly lower hospital readmission and mortality rates, and almost 10% higher satisfaction scores than comparable patients. Presbyterian also had lower patient costs that resulted from shorter patient hospital stays and the use of fewer lab and diagnostic tests compared with patients in hospital acute care.

Despite the success of the Hospital at Home program, Leff said, implementation of the program on a wide scale has been limited by the assumption that hospital care is safer, and by payment issues with Medicare. There are no payment codes for Hospital at Home care in fee-for-service Medicare, so implementation has been limited to Medicare managed-care and Veterans Affairs health systems.

The study appears in the June issue of Health Affairs. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/JHoUcY.

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