Key result
Hospital-in-Home services for veterans reduced average per-person costs ($7,792 vs $10,960) and 30-day nursing home admissions (3.1% vs 12.6%, P<0.001) compared to traditional inpatient care.
Why the study?
Does Hospital-in-Home care reduce costs and adverse outcomes compared to traditional inpatient care in veterans requiring acute care?
Cohort (n=832)
No
Does Hospital-in-Home care reduce costs and adverse outcomes compared to traditional inpatient care in veterans requiring acute care?
Absolute Event Rate: 3.1% vs 12.6%
p-value: p=<0.001
Hospital-in-Home care is a cost-effective alternative to traditional inpatient care that reduces subsequent nursing home admissions without compromising mortality or readmission rates.
May support Hospital-in-Home for veterans; hypothesis-generating and leaves open need for RCTs before practice change.
OBJECTIVES: To examine hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. DESIGN: Retrospective cohort study. SETTING: Cincinnati Veterans Affairs Medical Center (VAMC). PARTICIPANTS: Study cohort included veterans who received HIH services as an alternative to inpatient care between October 1, 2012, and November 30, 2015, and non-HIH veterans who were hospitalized for similar conditions in the Cincinnati VAMC during the same period. We identified 138 veterans who used HIH services and 694 non-HIH veterans. INTERVENTION: HIH veterans received hospital-equivalent care at home. Non-HIH veterans received traditional inpatient services in the Cincinnati VAMC. MEASUREMENTS: Total costs of care for treating an acute episode (HIH services vs inpatient) and likelihood of hospital readmission, death, or nursing home admission within 30 days of discharge from HIH services or hospitalization. RESULTS: Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P<0.001). HIH veterans were less likely to use a nursing home within 30 days of discharge (3.1%) than non-HIH veterans (12.6%) (P<0.001). Thirty-day readmission rates and mortality were not statistically different between HIH and non-HIH veterans. CONCLUSION: The substitutive HIH model implemented in the Cincinnati VAMC delivered acute services in veterans' homes at lower cost and with lower likelihood of postdischarge nursing home use. Broader implementation of this innovative delivery model may benefit older adults in need of care while reducing healthcare system costs.
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Cai et al. (2018) conducted a cohort in acute conditions requiring hospitalization (n=832). Hospital-in-Home (HIH) services vs. traditional inpatient services was evaluated on nursing home admission within 30 days of discharge (p=<0.001). Hospital-in-Home services for veterans reduced average per-person costs ($7,792 vs $10,960) and 30-day nursing home admissions (3.1% vs 12.6%, P<0.001) compared to traditional inpatient care.
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