Healthcare providers bear the significant responsibility of delivering optimal care based on patients’ symptoms and clinical requirements. In the realm of acute care in the U.S., decisions often revolve around determining the most suitable level of care, such as choosing between observation-care status and full inpatient admission. However, an emerging option for acute care treatment, known as hospital-at-home, is gaining momentum.

What is Hospital-at-Home?

Hospital-at-home is a healthcare model aimed at delivering acute-level services in a home environment, akin to those provided in a hospital setting. These programs are expanding, with a notable acceleration following the launch of the “Hospitals without Walls” initiative by the Centers for Medicare & Medicaid Services (CMS) in March 2020. This initiative allowed hospitals to transfer patients to various healthcare-providing facilities, including patients’ homes, while still receiving Medicare payments for the care delivered.

In a hospital-at-home program, a multidisciplinary team, akin to those in hospitals, manages the patient’s condition and provides access to necessary interventions such as IV fluids and oxygen. It’s important to note what hospital-at-home is not: it should not be conflated with traditional home care, enhanced primary care, or other levels of care like ongoing chronic condition management. Rather, it serves as an alternative to hospital admission, ensuring patients have access to acute healthcare services without restricting access to specialty care.

The ongoing strain on hospital beds worldwide, exacerbated by the SARS-CoV-2 outbreak, highlights the potential of hospital-at-home to manage additional patients needing acute care while minimizing exposure risks in traditional hospital settings. Moreover, patients receiving care at home may experience reduced risks of hospital-acquired infections and other harms associated with inpatient care.

Research Compares Outcomes Between Hospital-at-Home and Inpatient Care

Research comparing outcomes between hospital-at-home and inpatient care, such as a systematic review published in JAMA in June 2021, indicates favorable results for hospital-at-home. While treatment duration may be longer in the home setting, patients experience lower readmission rates, reduced risks of long-term care facility admission, and lower rates of depression and anxiety.

The Criteria

To support appropriate hospital-at-home placement, MCG has developed evidence-based clinical indications. These guidelines offer criteria for adult patients with specific diagnoses like cellulitis, chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, and urinary tract infections.

References

1. Hospital-at-home: AHA [Internet]. [cited 2024 Jun 13]. Available from: https://www.aha.org/hospitalathome
   
   
2. Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge | CMS [Internet]. www.cms.gov. Available from: https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19
   
   
3. ‌Arsenault-Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta-analysis. JAMA network open. 2021 Jun 1;4(6):e2111568-.