New Research Links Hospital-at-Home Care to Positive Patient Outcomes

New research from Mass General Brigham affirms the clinical benefits of hospital-at-home programs, showing that they are associated with low mortality, skilled nursing facility use, and readmission rates at one month following discharge.

The researchers published a letter in the Annals of Internal Medicine detailing the clinical outcomes associated with the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver, launched in November 2020. The waiver lifts certain Medicare Hospital Conditions of Participation, such as requiring nursing services to be provided on premises 24 hours a day, seven days a week. This allows approved hospitals to provide hospital-level inpatient care in Medicare patients’ homes. As of December 14, 2023, 308 hospitals across 37 states had been approved for the waiver.

For the study, researchers used 100 percent Medicare fee-for-service Part A claims for care delivered between July 1, 2022, and June 30, 2023, to identify all patients with an admission under the waiver. They examined various patient outcomes, including mortality and escalation — that is, returning to the hospital for one or more midnights — during the at-home hospitalization and skilled nursing facility use, mortality, and readmission 30 days after discharge.

The researchers examined data for 5,132 receiving hospital-at-home care under the waiver. A vast majority of the patients were White (85.2 percent), 41.7 percent were aged 80 years or older, 13.8 percent were dual-eligible, and 1.7 percent lived in a rural area.

The patient population was medically complex: 42.5 percent had heart failure, 43.3 percent had chronic obstructive pulmonary disease, 22.1 percent had cancer, and 16.1 percent had dementia.

The study shows that the mean length of stay was 6.3 days. The escalation rate during hospitalization was 6.2 percent, and the mortality rate was 0.5 percent.

At 30 days post-discharge, the mortality rate was 3.2 percent, the rate of skilled nursing facility use was 2.6 percent, and the readmission rate was 15.6 percent.

In a stratified analysis of patients from underserved groups, like Black and Latino, dual-eligible, and disabled patients, researchers found that these outcomes 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,” said corresponding author David Michael Levine, MD, clinical director for research and development for Mass General Brigham’s Healthcare at Home, in a press release. “This suggests home hospital can really reach a diverse group of patients and families.”

The researchers noted the study’s limitations, including that the results are generalizable only to the Acute Hospital Care at Home initiative within traditional Medicare, but concluded that the study results suggest “[the Acute Hospital Care at Home initiative] is an important care model to manage acute illness, including among socially vulnerable and medically complex patients.”

The study aligns with recent research by CMS showing that patients receiving care under Acute Hospital Care at Home waiver experienced a low mortality rate and minimal complications resulting in admission to brick-and-mortar hospitals.

Published last November, the study examined patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023.

The researchers found that 7.20 percent of the patients were transferred from home to the hospital. There were 38 unexpected deaths (0.34 percent) in hospital-at-home programs at participating hospitals, with most occurring among COVID-19 patients that progressed to more severe illness symptoms.

Despite growing evidence backing the waiver, it is not permanent and will expire at the end of 2024.

“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care. But in the last 40 years, there’s been a global movement to bring care back to the home,” said Levine. “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.”