A nationwide study on "hospital at home" programs, led by Dr. David Michael Levine of Mass General Brigham Hospital’s Healthcare at Home program, has reported promising outcomes. As detailed in the January 9 report in the Annals of Internal Medicine, these programs, which cater to patients suffering from heart disease, chronic obstructive pulmonary disease, cancer, and dementia, have shown a remarkably low mortality rate of 0.5%.
The study scrutinized outcomes for 5,858 nationwide enrolled in hospital-at-home programs under federal government waivers over one year, analyzing Medicare fee-for-service claims from July 1, 2022, to June 30, 2023. Patients presented a range of complex medical conditions. Among the patients, 43.3% were diagnosed with chronic obstructive pulmonary disease, 42.5% exhibited cardiac conditions, 22.1% had cancer, and 16.1% presented with dementia.
In addition to the low mortality rate, the study underscored other favorable results, such as a 6.2% escalation rate, reflecting the percentage of patients who needed to return to the hospital for a minimum of 24 hours. Dr. Levine emphasized the importance of additional research to establish a benchmark for an acceptable escalation rate, proposing that a rate below 10% might be considered reasonable.
Post-discharge data revealed that 3.2% of the patients died, 2.6% were transferred to skilled nursing facilities, and 15.6% faced hospital readmission. The study observed similar outcomes among patients from diverse racial and ethnic groups, suggesting equitable care delivery.
The study identified a challenge in geographical diversity, with only 1.7% of participants from rural areas. Despite staffing challenges, Levine pointed out the need to expand these programs to rural settings.
With the extension of government waivers that supported these programs during the COVID-19 pandemic, there is an ongoing discussion about the future of hospital-at-home programs. Healthcare advocates are pushing for these changes to become permanent, recognizing the potential benefits for Medicare beneficiaries.
This study offers valuable insights into the hospital-at-home care model, indicating its effectiveness and highlighting areas for improvement.
