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hospital at home; home hospital; admission avoidance

Indications: - heart failure - COPD exacerbation - asthma exacerbation - pneumonia - ischemic stroke - cellulitis * some 60 acute conditions can be safely treated at home. [12] Procedure: - median of 1 visit from a physician per day (range, 1-3) - 2 visits from a nurse (range, 2-4) [7] - bundled hospital-at-home + 30 day postacute transitional care [9] Clinical significance: - significantly fewer laboratory orders compared with controls* (median per admission: 6 vs 19) [7] - fewer consultations (0% vs 27%) - home patients with > twice as much daily physical activity (median minutes, 209 vs 78) - home patients tended to get more sleep (5.4 hours vs 4.1) [7] - long emergency department waits may be avoided - in hospital delirium may be avoided [13] - hospital-acquired infections may be avoided [7] - long-term care may be delayed or avoided [13] * control is usual hospital-based care Complications: - 3 main risk factors for medication errors in the home: - transition documentation - medication reconciliation - communication among the multidisciplinary team [15] * pharmacist should be included as a member of the care team [15] Notes: - patient & family choice of traditional inpatient care over hospital at home care based on estimates of safety, hospital personnel & burden on family members - hospital at home lowers costs compared with usual hospital care (by 50%), with no reduction in quality or safety [7] - hospital at home with comprehensive geriatric assessment results in similar outcomes as hospital admission in older persons living at home & decreases admissions to long-term residential care at 6 months [14] - may lower costs, use of health care resources, & readmission rates [11] - reduces 6-month mortality relative to standard care - improved patient statisfaction - diminished caregiver stress - lower rate of transfer to a nursing facility than traditional inpatient care - no specific billing codes for hospital at home care - applicable medicare billing codes in include outpatient, home or domiciliary physician visits & skilled home-healthcare - reimbursements are far lower than if patient receives care in hospital

General

hospital home care

References

  1. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  2. Leff B, Burton L, Mader SL et al Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005 Dec 6;143(11):798-808. PMID: 1633079
  3. Shepperd S, Doll H, Angus RM, Admission avoidance hospital at home. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007491. Review. PMID: 18843751
  4. Tibaldi V, Isaia G, Scarafiotti C, et al Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial. Arch Intern Med. 2009 Sep 28;169(17):1569-75. PMID: 19786675
  5. Cryer L, Shannon SB, Van Amsterdam M, Leff B. Costs for 'hospital at home' patients were 19 percent lower, with equal or better outcomes compared to similar inpatients. Health Aff (Millwood). 2012 Jun;31(6):1237-43. PMID: 22665835 Free Article
  6. Utens CM, van Schayck OC, Goossens LM et al Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial. Int J Nurs Stud. 2014 Aug;51(8):1093-102. PMID: 24486163
  7. Frellick M 'Home Hospital' Halves Costs in Small Randomized Trial - Medscape - Feb 09, 2018. https://www.medscape.com/viewarticle/892545 - Levine DM, Ouchi K, Blanchfield B et al Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. J Gen Intern Med. 2018 Feb 6. PMID: 29411238
  8. Truesdale PE. The hospital versus the home in the care of the sick; an evolution. JAMA. 2014 Mar 12;311(10):1073. PMID: 24618979
  9. Federman AD, Soones T, DeCherrie LV et al Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences. JAMA Intern Med. Published online June 25, 2018 PMID: 29946693 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2685092 - Liao JM, Navathe A, Press MJ Hospital-at-Home Care Programs - Is the Hospital of the Future at Home? JAMA Intern Med. Published online June 25, 2018. PMID: 29946679 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2685091
  10. Murali N, Messina T. No Place Like Home: Bringing Inpatient Care to the Patient. NEJM Catalyst. Aug 15, 2019 https://catalyst.nejm.org/no-place-home-recovery-care/
  11. Levine DM, Ouchi K, Blanchfield B et al Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2019. Dec 17 PMID: 31842232 https://annals.org/aim/article-abstract/2757637/hospital-level-care-home-acutely-ill-adults-randomized-controlled-trial - Wong JB, Cohen JT Hospital Care at Home: Better, Cheaper, Faster? Ann Intern Med. 2019. Dec 17 PMID: 31842205 https://annals.org/aim/article-abstract/2757848/hospital-care-home-better-cheaper-faster
  12. Terry K CMS Launches Hospital-at-Home Program to Free Up Hospital Capacity. Medscape - Nov 30, 2020 https://www.medscape.com/viewarticle/941767
  13. Shepperd S et al. Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons? A randomized trial. Ann Intern Med 2021 Apr 20; [e-pub]. PMID: 33872045 https://www.acpjournals.org/doi/10.7326/M20-5688 - Titchener K et al. Hospital at home for older patients with underlying comorbidity. Ann Intern Med 2021 Apr 20; [e-pub] PMID: 33872040 https://www.acpjournals.org/doi/10.7326/M21-1373
  14. Shepperd S, Butler C, Cradduck-Bamford A et al Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? A Randomized Trial. Ann Intern Med. 2021. Apr 20 PMID: 33872045
  15. Dionisi S, Di Simone E, Liquori G et al Medication errors' causes analysis in home care setting: A systematic review. Public Health Nurs. 2021 Dec 30. PMID: 34967458 https://psnet.ahrq.gov/issue/medication-errors-causes-analysis-home-care-setting-systematic-review
  16. Levine DM et al. Acute hospital care at home in the United States: The early national experience. Ann Intern Med 2024 Jan; 177:109 PMID: 38190713 https://www.acpjournals.org/doi/10.7326/M23-2264
  17. Kowalkowski M, Stephens C, Hetherington T et al Effectiveness of a Multifaceted Implementation Strategy to Increase Equitable Hospital at Home Utilization: An Interrupted Time Series Analysis. J Gen Intern Med. 2024 Jul 9. doi: 10.1007/s11606-024-08931-3. Online ahead of print. PMID: 38981943 https://link.springer.com/article/10.1007/s11606-024-08931-3