David M. Levine|Kei Ouchi|Bonnie B. Blanchfield|Keren Diamond|Adam Licurse|Charles T. Pu|Jeffrey L. Schnipper
Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial
Harvard University|Brigham and Women's Hospital|Harvard University|Brigham and Women's Hospital|Harvard University|Brigham and Women's Hospital|Mass General Brigham|Brigham and Women's Hospital|Mass General Brigham|Harvard University|Massachusetts General Hospital|Mass General Brigham|Harvard University|Harvard University|Brigham and Women's Hospital
hospitals standard care acute illness hospitals unsafe uncomfortable expensive providing substitutive hospitallevel care patients home potentially reduces cost maintaining improving quality safety patient experience although evidence randomized controlled trials us lackingdetermine home hospital care reduces cost maintaining quality safety patient experiencerandomized controlled trialadults admitted via emergency department infection exacerbation heart failure chronic obstructive pulmonary disease asthmahome hospital care including nurse physician home visits intravenous medications continuous monitoring video communication pointofcare testingprimary outcome direct cost acute care episode secondary outcomes included utilization 30day cost physical activity patient experiencenine patients randomized home 11 usual care median direct cost acute care episode home patients 52 iqr 28 p 005 lower control patients care episode home patients fewer laboratory orders median per admission 6 vs 19 p 001 less often received consultations 0 vs 27 p 004 home patients physically active median minutes 209 vs 78 p 001 trend toward sleep adverse events occurred home patients one occurred control patients median direct cost acute care plus 30day postdischarge period home patients 67 iqr 77 p 001 lower trends toward less use homecare services 22 vs 55 p 008 fewer readmissions 11 vs 36 p 032 patient experience similar groupsthe use substitutive homehospitalization compared inhospital usual care reduced cost utilization improved physical activity significant differences quality safety patient experience noted definitive results awaiting larger trial trial registration nct02864420