Small pilot trial finds reduced costs but similar quality, safety with home hospital versus usual care

Home hospital care included home visits from nurses and physicians, IV medications, continuous monitoring, video communication, and point-of-care testing.

Home hospitalization reduced costs and resource use and improved patients' physical activity but did not differ from in-hospital care in quality, safety, or patient experience, a recent study showed.

Researchers performed a randomized controlled trial at two facilities to compare the effects of home hospital care with usual hospitalization. Adult patients admitted through the ED with infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma were assigned to home hospital (including home visits from nurses and physicians, IV medications, continuous monitoring, video communication, and point-of-care testing) or usual care. The trial's primary outcome was the direct costs of the acute care episode, while secondary outcomes included health care utilization, cost over 30 days, physical activity, and patient experience. The study results were published online Feb. 6 by the Journal of General Internal Medicine.

Fifty-seven patients were evaluated for inclusion in the study, and of these, nine were assigned to home hospital and 11 were assigned to usual care. In the home hospital group, mean age was 65 years, 22% were women, and 44% were white. The usual care group was younger (mean age, 60 years) and included a greater percentage of women (73%). Patients in both groups were interviewed at admission, at discharge, and 30 days after discharge. The median direct cost of the acute care episode was 52% lower for home hospital patients than for usual care patients (P=0.05). Laboratory orders (median per admission, 6 vs. 19; P<0.01) and consultations (0% vs. 27%; P=0.04) were less common during the acute care episode for home hospital patients versus usual care, and home hospital patients were more physically active (median minutes, 209 vs. 78; P<0.01).

When direct costs for acute care were combined with costs for the 30-day postdischarge period, home hospital patients' costs were 67% lower than those for usual care patients (P<0.01). In addition, home care services and readmission rates trended lower among home hospital patients than among those assigned to usual care (22% vs. 55% [P=0.08] and 11% vs. 36% [P=0.32], respectively). Adverse event rates were low in both groups (no events in the home care group and one event in the usual care group), and patient experience was similar, with both groups reporting high global satisfaction and stating that they would always recommend their experience to others.

The authors noted that their sample size was small, meaning that adjustments could not be made for clinically significant differences between groups and that their study was underpowered to detect differences for many of the secondary outcomes. In addition, they pointed out that their results may have limited generalizability since they recruited patients from only two sites and that a large number of eligible patients (63%) declined to participate. However, they concluded that based on their results, home hospital care improves costs, utilization, and physical activity while appearing to maintain quality, safety, and patient experience versus usual care. They called for a larger trial to confirm their results.