The hospital-at-home model continues to show more signs of low rates of mortality, decreased usage of skilled nursing facilities and less need for escalation in patient care compared to traditional care settings.
That’s according to a new study from Mass General Brigham, which shows the value and efficacy of hospital-level care in a home setting.
“The care that’s been delivered nationally is to very complex patients who are acutely ill,” Dr. David Levine, clinical director for research and development for Mass General Brigham’s Healthcare at Home, told HHCN. “That’s the number one takeaway from this. A lot of people have asked, ‘Does hospital-at-home cherry pick? Are these patients actually getting hospital-level care?’ For the first time, we’re seeing national data that’s suggesting that these patients are highly complex and they’re acutely ill.”
Since the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in response to the COVID-19 pandemic, patient outcomes have been encouraging.
In a study published in JAMA, only 7.2% of over 11,000 patients that were being treated in the home were transferred to the hospital. Mass Brigham’s study showed even more encouraging results.
Mass Brigham’s HAH program serves 66 neighborhoods across the Boston area. Levine and the research team delved into the clinical characteristics and outcomes of over 5,800 patients who received care under the AHCAH waiver.
Patients in the HAH program were found to have a 0.5% mortality rate and only 6.2% of patients returned to the hospital for at least 24 hours.
One of the more impressive aspects of the HAH model, Levine said, is that complex and acutely ill patients are being treated in the home. The patients included in the study had medically complex conditions: 42.5% had heart failure, 43.3% had chronic obstructive pulmonary disease, 22.1% had cancer and 16.1% had dementia.
“This is really delivering substitutive hospital level, which is really exciting,” Levine said. “These are folks who are quite complex, so it’s really reassuring that this care model — if we were able to scale it and if we’re able to continue the waiver — could see this care get to tens of thousands, if not hundreds of thousands, of patients across the country.”
The second major takeaway Levine found in digging through the study’s findings was the “substantial equity” given and observed in the HAH model.
“We know that there are lots of disparities in outcomes after hospitalization,” Levine said. “Very sadly, that’s a reality in our country. When we broke that down for this population, you don’t see that.”
Outcomes remained consistent across all demographic groups, including Black, Latino, and other race and ethnicity demographics, as well as dual-eligible and disability status.
“That speaks volumes to the fact that when you’re delivering care in people’s homes, even when they’re acutely ill, we’re able to really level the playing field and, if not, serve some of those patients who are traditionally disadvantaged, even better than the hospital does potentially,” Levine said.
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