Evaluation of a hospital-in-home program implemented among veterans

Am J Manag Care. 2017 Aug;23(8):482-487.

Abstract

Objectives: To examine the outcomes (ie, costs, hospitalizations, and mortality) associated with a Hospital-in-Home (HIH) program implemented in 2010 by the Veterans Affairs (VA) Pacific Islands Healthcare System in Honolulu, Hawaii.

Study design: Retrospective cohort study.

Methods: We obtained medical information for veterans who were enrolled in the HIH program in Honolulu, Hawaii, between 2010 and 2013. For purposes of comparison, we also gathered VA data to identify a cohort of hospitalized veterans in Honolulu who were eligible for, but not enrolled in, the HIH program. Using VA administrative data, we extracted a set of individual-level variables at baseline to account for the differences between program enrollees and comparators. In total, 99 HIH program enrollees and 322 unenrolled veterans were included. We identified 3 sets of outcome variables: total costs of care related to the index event (ie, HIH services for enrollees and hospitalizations for comparators), hospitalizations, and mortality after discharge from the index event. We used a propensity score-matching approach to examine the difference in related outcomes between enrollees and comparators.

Results: The average medical cost was $5150 per person for veterans receiving HIH services, and $8339 per person for veterans receiving traditional inpatient services. The difference was statistically significant (P <.01). There was no statistically significant difference in mortality or hospitalization rates after the index event.

Conclusions: This study provides evidence of the potential benefits of a model that delivers acute care in patients' homes. Considering the emergence of accountable healthcare organizations, interest in broader implementation of such programs may be worthy of investigation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Home Care Services / economics*
  • Home Care Services / organization & administration
  • Hospitalization / economics*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Mortality*
  • Retrospective Studies
  • United States
  • United States Department of Veterans Affairs
  • Veterans*