Safety and implementation of a regional hospital-at-home model: a retrospective observational study from Denmark

To describe the patient population, care pathways, and short-term safety outcomes of a regional hospital-at-home model in Region Zealand, Denmark, between 2022 and 2024, and to explore variation in outcomes by diagnosis and referral source. Retrospective observational study using registry-based data and internal monitoring records. A publicly funded, cross-sectoral hospital-at-home service coordinated centrally and delivered via municipal nurses and mobile treatment units. We included 2,511 patients with a median age of 72 years (IQR 60–80). Patients generally presented with substantial comorbidity and represented a broad, clinically diverse population. Length of stay, unplanned hospital contacts during treatment or within 24 h after planned completion, 30-day readmissions, and 30-day survival. The median length of stay increased from 5.1 days in 2022 to 7.3 days in 2024. Rates of unplanned hospital contacts remained stable (27.0–31.1%), whereas 30-day readmission rates declined from 11.0% to 7.0% over the study period. Thirty-day survival remained consistently high (91.6–92.4%). Infectious diseases were the most frequent diagnostic category (43–47%). Outcomes varied by diagnosis and referral source, with longer treatment durations observed among patients with orthopaedic and chronic conditions. Hospital-level care delivered in patients’ homes was implemented on a regional scale with acceptable short-term outcomes across a clinically complex and socially diverse patient population, including individuals living alone. The variation in outcomes across diagnostic groups underscores the importance of flexible, diagnosis-informed care pathways and structured cross-sectoral organisation in hospital-at-home models. Not applicable. This study includes a large, regional cohort of patients receiving hospital-level care at home, capturing real-world implementation across a publicly funded, cross-sectoral healthcare system. The comprehensive linkage of registry data enabled a robust assessment of short-term outcomes, including readmissions, unplanned hospital contacts, and mortality, with minimal loss to follow-up. The study population was clinically complex and socially diverse, including a high proportion of older adults, patients with substantial comorbidity, and individuals living alone. The observational design without a control group limits causal inference and precludes direct comparison with traditional inpatient hospital care. The data did not include patient-reported outcomes or detailed information on in-home clinical processes, which limits insight into patient experience and specific care components.