Virtual acute care at home cuts length of hospital stay

New research shows that patients with acute illnesses who received virtual and at-home care with remote patient monitoring and as-needed in-person urgent care visits had shorter hospital stays than patients who received standard inpatient hospital care.

For the study, researchers assessed the Safer@Home care model launched at the Los Angeles General Medical Center in September 2022. The care model is an expanded version of a virtual and at-home acute care model launched in 2020 for COVID-19 pneumonia patients requiring oxygen. The Safer@Home model cares for a wider array of acute conditions, including heart failure exacerbation, bacterial pneumonia and diabetic foot infection.

The Safer@Home model is similar to the hospital-at-home care model popularized by the federal Acute Hospital Care at Home (AHCAH) waiver, which allows hospitals to forgo certain Medicare conditions of participation to provide acute, hospital-level care at home. However, even under the waiver, hospitals must adhere to some Medicare standards, including vital signs measurement performed three times daily in the patient's home. Thus, AHCAH participating hospitals require additional nursing staff and potentially extensive transit time.

As a result of these challenges, the Los Angeles County Department of Health Services has been unable to implement AHCAH programs, the study authors noted. Instead, it created the Safer@Home model, in which eligible patients are discharged to their homes and cared for via virtual clinical and remote patient monitoring services, oral or inhalational therapy, and return urgent care visits when in-person care is needed. The model does not involve at-home care personnel.

The researchers evaluated patient outcomes of the Safer@Home program from its launch on Sept. 1, 2022, through Aug. 31, 2023. They compared data for 876 Safer@Home patients with data for 1,590 matched controls, that is, patients with similar diagnoses who received standard inpatient care during the study period.

The study showed that Safer@Home patients had a significantly shorter overall mean length of stay (1.3 days) compared with matched control patients (5.3 days).

The proportion of Safer@Home and control patients with at least one return emergency department (ED) visit and hospital readmission within 30 days were not significantly different. However, patients in the Safer@Home cohort had a significantly lower mean rate of return ED visits per person than control patients during follow-up.

Additionally, there were no significant differences between mortality rates in the two groups at 30 days.

The study showed that the number of return visits to urgent care was much higher among Safer@Home patients. About 37.3% of Safer@Home patients required 538 return urgent care visits, while only 5.2% of control patients required 132 return urgent care visits. According to the researchers, this was an intentional "trade-off for substantially reducing inpatient stay."

"The higher urgent care utilization was a specifically intended mechanism of follow-up in the program, which sought to replace inpatient care with home care and with urgent care visits when remote monitoring of patient symptoms and vital signs warranted face-to-face evaluation," they wrote.

Thus, they concluded that the Safer@Home model could be a viable alternative to home-based care programs that require staff to visit patient homes.

The study comes amid growing evidence that acute care can be safely and effectively provided in patient homes.

A study published in October 2024 provided a detailed analysis of the AHCAH program, showing that it resulted in high-quality outcomes. Conducted by CMS, the study analyzed several aspects of the AHCAH initiative, gathering data from the 365 healthcare facilities approved for the waiver as of Oct. 7, 2024.

The study showed that the quality of care provided under the AHCAH program was on par with or better than that provided in brick-and-mortar inpatient settings. The study also revealed that the AHCAH-participating hospitals had lower mortality rates than their brick-and-mortar counterparts.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.