Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients

Ann Intern Med. 2005 Dec 6;143(11):798-808. doi: 10.7326/0003-4819-143-11-200512060-00008.


Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital.

Objective: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home.

Design: Prospective quasi-experiment.

Setting: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center.

Participants: 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.

Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital.

Measurements: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care.

Results: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001).

Limitations: Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences.

Conclusions: The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease / therapy*
  • Aged
  • Aged, 80 and over
  • Cellulitis / complications
  • Cellulitis / therapy
  • Community-Acquired Infections / complications
  • Community-Acquired Infections / therapy
  • Feasibility Studies
  • Female
  • Health Services for the Aged / economics
  • Health Services for the Aged / organization & administration*
  • Health Services for the Aged / standards
  • Home Care Services, Hospital-Based / economics
  • Home Care Services, Hospital-Based / organization & administration*
  • Home Care Services, Hospital-Based / standards
  • Hospitalization / economics
  • Humans
  • Length of Stay
  • Lung Diseases, Obstructive / complications
  • Lung Diseases, Obstructive / therapy
  • Male
  • Outcome Assessment, Health Care*
  • Pneumonia / complications
  • Pneumonia / therapy
  • Program Evaluation
  • Prospective Studies
  • Selection Bias
  • United States