Hospital at home care combined with 30-day post-acute transition care was associated with significantly lower costs than inpatient care (adjusted difference -$5977; 95% CI -$10,758 to -$1196; p=0.01).
Cohort (n=302)
No
Does hospital at home care reduce acute and 30-day post-acute costs compared to traditional inpatient care in adults requiring hospital admission?
Hospital at home care combined with 30-day post-acute transition care significantly reduces total costs compared to traditional inpatient care.
Mean Difference: -5977 (95% CI -10758–-1196)
p-value: p=0.01
BACKGROUND: Previous studies have demonstrated that hospital at home (HaH) care is associated with lower costs than traditional hospital care. Most prior studies were small, not U. S. -focused, or did not include post-acute costs in their analyses. Our objective was to determine if combined acute and 30-day post-acute costs of care were lower for HaH patients compared to inpatient comparisons in a Center for Medicare and Medicaid Innovation Center demonstration of HaH. METHODS: A single-center New York City retrospective observational cohort study of patients admitted to either HaH or inpatient care from September 1, 2014 through August 31, 2017. Eligible patients were 18 years or older, required inpatient admission, lived in Manhattan, and met home safety requirements. Comparison individuals met the same criteria and were included if they refused HaH care or were admitted when HaH was not available. HaH care was substitutive hospital-level care and 30-days of post-acute transitional care. Main outcomes were costs of care of the acute and post-acute 30-day episodes. We matched subjects on age, sex, and insurance and conducted regression analyses using an unadjusted model and one adjusted for several patient characteristics. RESULTS: Of 523 Medicare admission episodes, data were available for 201 episodes in the HaH arm and 101 episodes of usual care. HaH patients were older (81. 6 SD = 12. 3 years vs. 74. 6 SD = 14. 0, p < 0. 0001) and more likely to have activities of daily living (ADL) impairments (75. 4% vs. 46. 5%, p < 0. 0001). Unadjusted mean costs were 5054 lower for HaH episodes compared to inpatient episodes. Regression analysis with matching showed HaH costs were 5116 (95% CI -10, 262 to 30, p = 0. 05) lower, and when adjusted for age, sex, insurance, diagnosis, and ADL impairments, 5977 (95% CI -10, 758 to -1196, p = 0. 01) lower. CONCLUSIONS: HaH combined with 30-day post-acute transition care was less costly than inpatient care.
Saenger et al. (2022) conducted a cohort in Patients requiring inpatient admission (n=302). Hospital at home (HaH) care vs. Inpatient care was evaluated on Costs of care of the acute and post-acute 30-day episodes (MD -5977, 95% CI -10758 to -1196, p=0.01). Hospital at home care combined with 30-day post-acute transition care was associated with significantly lower costs than inpatient care (adjusted difference -$5977; 95% CI -$10,758 to -$1196; p=0.01).