First-in-the-US study brings home hospital model to patients

February 7, 2018, Brigham and Women's Hospital
Credit: CC0 Public Domain

A pilot study by investigators at Brigham and Women's Hospital reimagines the best place to care for select, acutely ill adults. The project poses the question: what if, instead of being admitted and receiving care at a hospital, a patient could be cared for at home, and monitored using cutting-edge technology? The study represents the first randomized, controlled clinical trial to test the home hospital model in the U.S. and examined the model's impact on direct cost as well as utilization, safety, quality, and patient experience. Results of the pilot project are reported this week in The Journal of General Internal Medicine.

"We haven't dramatically changed the way we've taken care of acutely ill patients in this country for almost a century," said David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care at BWH and lead author of the study. "There are a lot of unintended consequences of hospitalization. Being able to shift the site of care is a powerful way to change how we care for acutely ill patients and it hasn't been studied in the U.S. with intense rigor. That was the impetus for our project."

The recruited a total of 20 adult patients admitted to the emergency department at Brigham and Women's Hospital or Brigham and Women's Faulkner Hospital. Eligible participants included patients with any infection or exacerbations of heart failure, chronic obstructive pulmonary disease or asthma. Participants also had to live in the surrounding area of the hospital to qualify for the study. Nine patients were randomized to receive care at home while 11 received usual care within the hospital setting.

Patients who were cared for at home received a daily visit from an attending general internist and two daily visits from a home health registered nurse. The home hospital model also offered 24-hour physician coverage and cutting-edge connectivity, including continuous monitoring, video and texting. Patients in either arm of the study were interviewed on admission, at discharge and 30-days after discharge.

The team found that the average direct cost for acute care episodes for home patients was up to half of the cost of the control patients cared for in the hospital. The pilot study's primary outcome was direct cost but the researchers also looked at other, secondary measures. They found that the home hospital model also decreased utilization and improved physical activity, without appreciably changing quality, safety, or .

"The home hospital model delivers care in a more patient-centered manner: patients can be surrounded by their family and friends, eat their own food, move around in their own home, and sleep in their own bed, with the supports of the home team," said Levine.

Levine is already conducted a larger scale trial to demonstrate these pilot results in a larger group of .

Explore further: Is your own MD best in the hospital? Study eyes hospitalists

More information: David M. Levine et al, Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial, Journal of General Internal Medicine (2018). DOI: 10.1007/s11606-018-4307-z

Related Stories

Is your own MD best in the hospital? Study eyes hospitalists

November 13, 2017
The old-fashioned, family doctor style of medicine could be lifesaving for elderly hospitalized patients, a big study suggests, showing benefits over a rapidly expanding alternative that has hospital-based doctors overseeing ...

Hospital discharge program improves patient experience leaving the hospital

July 6, 2017
A standardized, in-hospital discharge planning program, known as Project ReEngineered Dishcharge (RED), improves patient experience as they leave the hospital, according to researchers at Boston Medical Center. The study, ...

Clinical trial finds virtual ward does not reduce hospital readmissions

September 30, 2014
A virtual ward, a new model of care that provides support to high-risk and complex patients in the community for a few weeks after discharge from hospital, did not prevent hospital readmissions as hoped in a clinical trial ...

Major communication gaps between doctors and home health care nurses revealed

July 19, 2017
Researchers at the University of Colorado Anschutz Medical Campus have found serious gaps in communication between physicians and home health care agencies responsible for caring for often elderly patients discharged from ...

Perioperative Surgical Home reduces death, ER visits in elderly hip fracture patients

October 22, 2017
Elderly patients who had emergency repair of a fractured hip were much less likely to die or make a return visit to the emergency room (ER) after discharge if they received care under the Perioperative Surgical Home (PSH) ...

Choosing to die at home does not hasten death for patients with terminal cancer

March 28, 2016
A large study from Japan found that cancer patients who died at home tended to live longer than those who died in hospitals. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings ...

Recommended for you

Sweet, bitter, fat: New study reveals impact of genetics on how kids snack

February 22, 2018
Whether your child asks for crackers, cookies or veggies to snack on could be linked to genetics, according to new findings from the Guelph Family Health Study at the University of Guelph.

The good and bad health news about your exercise posts on social media

February 22, 2018
We all have that Facebook friend—or 10—who regularly posts photos of his or her fitness pursuits: on the elliptical at the gym, hiking through the wilderness, crossing a 10K finish line.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Tackling health problems in the young is crucial for their children's future

February 21, 2018
A child's growth and development is affected by the health and lifestyles of their parents before pregnancy - even going back to adolescence - according to a new study by researchers at the Murdoch Children's Research Institute, ...

Lead and other toxic metals found in e-cigarette 'vapors': study

February 21, 2018
Significant amounts of toxic metals, including lead, leak from some e-cigarette heating coils and are present in the aerosols inhaled by users, according to a study from scientists at Johns Hopkins Bloomberg School of Public ...

Why teens need up to 10 hours' sleep

February 21, 2018
Technology, other distractions and staying up late make is difficult, but researchers say teenagers need to make time for 8-10 hours of sleep a night to optimise their performance and maintain good health and wellbeing.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.