A pilot study by investigators at Brigham and Women's Hospital has found a shift to home-based care for selected acutely ill patients could cut costs while producing benefits for patients. The study, which was published in The Journal of General Internal Medicine, represents the first randomized, controlled clinical trial in the United States to test the home hospital model.
The study's data show 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 potential implications are enormous, according to lead author David Levine, MD, MPH, MA.
"Hospitalization represents about a third of the roughly $1 trillion in annual health care expenditures in the United States," said Dr. Levine, a physician and researcher in the Brigham's Division of General Internal Medicine and Primary Care. "Saving a nice chunk of that through home hospitalization would produce massive savings that could be directed toward research and other public health endeavors."
The study recruited 20 adult patients admitted to the emergency department at the Brigham 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. Nine patients were randomized to receive care at home, while 11 received usual care within the hospital setting.
Patients admitted to home hospital care received a daily visit from an attending general internist and two daily visits from a registered home health nurse. They also benefited from 24-hour physician coverage and cutting-edge connectivity, including continuous monitoring, video and texting.
In addition to cost savings, investigators found the home hospital model decreased utilization and improved physical activity without appreciably changing quality, safety or patient experience.
"While the cost savings are important, what's even more important is the care we deliver," Dr. Levine said. "Patients deserve high-quality, safe care and a great care experience. We deliver all of those either just as well or better at home"
Dr. Levine and his colleagues have already replicated the pilot study in a follow-up randomized control trial of a larger group of patients. The results, scheduled to be published in early 2019, essentially corroborate the key findings of the pilot study, but with statistically significant outcomes.
Moving toward value-based health care is not easy, but Dr. Levine believes the shift is necessary—and inevitable.
"Home hospitalizing patients isn't currently in the fee-for-service reimbursement schedule," he concluded. "But I think it will be in the future, and that's why Brigham is investing in the next model of care today. We know it's coming, and we want to help lead the way."
David M. Levine, MD, Division of General Internal Medicine & Primary Care at Brigham and Women’s Hospital, describes the home hospital, a novel care model that brings hospital services to patients at home.
