Kaiser Permanente Study Shows Scalability of Hospital-at-Home Model

Research from Kaiser Permanente reveals that its hospital-at-home program was scaled successfully, creating hospital capacity; however, the program’s care quality as it was being scaled could not be determined.

Published in The American Journal of Managed Care, the study aimed to assess the feasibility of scaling a hospital-at-home program within an integrated healthcare delivery system.

Though the hospital-at-home model has been around for decades, it received a significant boost when the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in November 2020. The waiver allows hospitals to provide inpatient-level care in the home for Medicare fee-for-service and non-managed care Medicaid beneficiaries. As of December 14, 308 hospitals across 37 states had been approved for the waiver.

Kaiser Permanente in the Portland, Oregon, metropolitan area launched a hospital-at-home program in April 2020 in collaboration with the Medically Home Group. Researchers conducted a retrospective cohort study of the Kaiser Permanente at Home program to determine its scalability.

Patients were admitted to the program through the emergency department. These patients were brought back home for treatment facilitated by technology and an in-home care team. A huddle is held each morning with team nurses, physicians, nurse practitioners, and a pharmacist. The team develops the care plan, and the attending physician performs pre-scheduled video visits to mirror rounds in the traditional hospital. The patient is provided various technologies, including a tablet to connect with the care team, wireless-enabled vital sign equipment, and an emergency response device attached to the wrist.

The researchers examined data for patients requiring hospital-level care between April 29, 2020, and November 14, 2021. These patients received care through Kaiser Permanente at Home or traditional inpatient care in the hospital.

The program was scaled in three stages during the study period: From April 29, 2020, to September 2020 (stage 1), the daily census was below ten patients; from October 2020 to February 2021 (stage 2), the daily census cap was 15 patients a day; and from March 2021 onwards (stage 3), the maximum daily census was raised to 25 patients a day.

During the study period, 1,005 patients were admitted to the Kaiser Permanente at Home program. The average daily census increased from 7.2 in stage 1 to 12.7 in stage 3 of the implementation. The median length of stay for hospital-at-home patients decreased from 7.43 days in stage 1 to 5.46 days during stage 3. Readmission rates dropped from 11.52 percent during stage 2 to 9.24 percent in stage 3.

Researchers also conducted a subgroup analysis comparing 59 Kaiser Permanente at Home patients to 1,738 admitted to traditional inpatient care. They found that both groups experienced a similar risk of 30-day readmission. Also, Kaiser Permanente at Home patients were numerically less likely to experience delirium than patients admitted to the traditional hospital setting. On the other hand, the hospital-at-home patients’ length of stay was 1.41 days longer than patients admitted to the traditional inpatient setting.

However, the researchers noted that “the imprecise comparisons in the small subgroup are unable to support equivalence for quality outcomes.”

Still, the researchers concluded that “Kaiser Permanente at Home can be implemented at scale for acute medical illness requiring hospital-level care as an alternative to traditional hospital care.”

The study adds to growing research on the hospital-at-home care model.

In November, CMS released results from an analysis of the first 16 months of the Acute Hospital Care at Home initiative. Researchers examined patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023. A total of 11,159 patients had received care under the waiver during the study period.

The study found that the overall proportion of patients transferred from home to the hospital was 7.20 percent. Thirty-eight unexpected deaths (0.34 percent) occurred in participating hospitals. Most of the unexpected deaths occurred among COVID-19 patients that progressed to more severe illness symptoms.

Thus, researchers concluded that patients receiving care under the waiver experienced a low mortality rate and minimal complications.