Abstract Introduction Hospital at Home (HAH) is an admission avoidance service where patients receive hospital-level care in their own homes. We conducted a retrospective cohort study to compare patient outcomes in older adults with community-acquired pneumonia (CAP) treated through HAH versus an acute frailty ward in hospital. HAH patients received once daily IV ceftriaxone whereas hospital inpatients were prescribed IV antibiotics as per hospital guidelines. Method All patients diagnosed with CAP requiring IV antibiotics under HAH and on an acute frailty ward were identified between January and December 2024. 52 patients discharged from hospital to HAH for continuing treatment of CAP were excluded from analysis. 12 HAH patients admitted to hospital during their HAH admission were also excluded from analysis. Results 64 HAH patients (mean age 85 years, average clinical frailty score of 7) and 108 hospital inpatients (mean age of 85 years, average frailty score of 5) were treated for CAP during the study period. Mean National Early Warning Score (NEWS) on admission was 4 for HAH patients compared to 3 for patients presenting to hospital. Average length of IV antibiotic treatment was 4 days under HAH and 5.5 days in hospital. Average length of stay for patients treated under HAH was 4 versus 14 days in hospital. 17% HAH patients developed an AKI compared to 25% of hospital inpatients. 9% HAH patients developed delirium whilst under HAH compared to 37% inpatients during their hospital stay. 33% HAH were palliative compared to 12% inpatients. 12-month mortality rate of HAH patients was 59% compared to 34% inpatients. Key Conclusion HAH offers an effective alternative to inpatient care for older adults with CAP, with shorter treatment duration, fewer complications, and reduced hospital stay. Higher mortality likely reflects greater frailty and palliative focus in the HAH cohort, as opposed to reduced care quality.
Behranwala et al. (Sun,) studied this question.