Researchers analyzing results from the Acute Hospital Care at Home (AHCaH) Waiver program say there is preliminary evidence suggesting that home hospital is an important care model for managing acute illness.
Thousands of patients from across 300 hospitals in 37 states have been treated in their homes since the waiver went into effect in 2020. Yet the researchers noted that little is understood about these patients’ outcomes on a national level, and the waiver will end in December 2024 unless there is an act from Congress to extend it.
Led by David Levine, M.D., M.P.H., M.A., clinical director for research and development for Mass General Brigham’s Healthcare at Home program, the researchers analyzed outcomes from AHCaH for a diverse group of patients across the country.
Levine and colleagues looked at clinical characteristics and outcomes from all of the 5,858 patients who were cared for under the AHCaH Waiver, using Medicare fee-for-service Part A claims filed between July 1 2022 and June 30 2023. Then they studied whether these clinical characteristics varied across different demographic groups.
Fifty-four percent of the patients were female, 85.2 percent were white, 61.8 percent were over 75 years old, and 18.1 percent were disabled. The mean household income was $83,932.
When the team studied hospitalizations among all these patients, they found a 0.5 percent mortality rate and 6.2 percent escalation rate (returning to the hospital for at least 24 hours). In addition, within 30 days of discharge, 2.6 percent of patients used a skilled nursing facility, 3.2 percent died, and 15.6 percent were readmitted.
The patients included in the current study had medically complex conditions, including 42.5 percent with heart failure, 43.3 percent with chronic obstructive pulmonary disease, 22.1 percent with cancer, and 16.1 percent with dementia. The five most common discharge diagnoses were heart failure, respiratory infection (including COVID), sepsis, kidney/urinary tract infections, and cellulitis.
The outcomes were also stratified by patients of Black and Latine race and ethnicity, dual-eligible status, and by disability status. The findings were consistent across all groups.
“It was reassuring to see that there were not clinically meaningful differences in outcomes across marginalized populations, because we know that there are massive disparities in outcomes for traditional hospitalization,” Levine said in a statement. “This suggests home hospital can really reach a diverse group of patients and families.”
Still, the findings are limited to observational data, and additional research is necessary to compare the measured outcomes to those at brick-and-mortar hospitals. Levine’s team is also currently studying home hospital care for rural patients, who were not well represented in the current study.
“We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
For decades, home hospital care has been offered all around the world,” Levine said. “This is an important moment in the United States where we might see a paradigm shift in how we deliver a sizeable portion of healthcare.”
