Home is Where…the Hospital Is

A Johns Hopkins Study Finds “Hospital at Home” Model Safe, Viable and Cost-Effective

A Johns Hopkins University study published today in the Annals of Internal Medicine show that a novel program that provides acute hospital care in a patient’s home—called Hospital at Home—is a safe, viable, and cost-effective alternative for some older patients.

Hospital at Home models have been tested in several countries, but the Hopkins study is believed to be first published research that examines the approach in American health care settings.

“Hospital care is not ideal for many older patients,” said Bruce Leff, MD, lead author of the study and associate professor at The Johns Hopkins University School of Medicine, noting that hospital stays are commonly associated with delirium, infection, functional decline, falls, incontinence and nursing home placement.

Conducted at hospitals in Buffalo, NY, Worcester, MA, and Portland, OR, the research began with patients 65 and older who needed acute care for four common conditions—pneumonia, chronic heart failure, COPD (chronic obstructive pulmonary disease) and cellulitis. Given the choice of hospital admission or care at home, more than three in five chose to receive care in their homes. 

“In our study,” said Dr. Leff, “Hospital at Home reduced complications, shortened the duration of care and lowered overall health care costs by one-third. It appears to be a feasible, patient-centered option for older adults suffering from common and serious age-related conditions. In short, patients who chose to have acute care at home, they got high quality care, and it cost less.”

The study found that the Hospital at Home patients had timely access to a doctor and nurse, actually received more personal nursing attention than is usual in the hospital, and had a lower risk of developing delirium or requiring sedatives.  “The patients and families in the study,” said Dr. Leff, ”also reported high levels of satisfaction with the care. Hospital at Home really worked for them.”

The American approach to the hospital-at-home model is distinguished by its high level of physician and nurse supervision and intensive levels of medical services, including oxygen therapy, IVs and, where indicated, full-time nursing care.

Reducing the Costs of Hospital Care for Older Adults

According to a 2005 report from the Center for Medicare and Medicaid Services (CMS), Medicare paid $116 billion last year in hospital care expenses for people 65 and older. In the Hospital at Home study, older patients receiving traditional care for one of the four conditions cost an average of $7,480 per stay. In contrast, average daily cost for Hospital at Home patients was $5,081, a 32 percent savings.

Based on data from the National Center for Health Statistics, the study team estimates that each year there are approximately 565,000 patients with these conditions who would also be eligible for Hospital at Home. Extrapolating from these data, the team projects an approximately $1.4 billion savings with the Hospital at Home model if all those eligible received this care. Additional cost-effectiveness research on Hospital at Home is necessary to confirm these data. 

“These kinds of potential savings are important to note,” said Lynda Burton, Sc.D., associate professor at the Johns Hopkins Bloomberg School of Public Health and one of the co-authors on the study, “especially given the current concern about rising health care costs and the growing number of older patients projected during the next several decades.” In future research, the Hospital at Home team also hopes to show that the model can also address the safety and other problems older adults face in care transitions, that is, as they move from the hospital to home or to another health care setting. “We believe Hospital at Home is an attractive option given the challenges and opportunities in today’s health care system,” said Dr. Burton.

The Hospital at Home study was supported by a grant from the John A. Hartford Foundation of New York and was supplemented at the Portland Veterans Affairs Medical Center by a Department of Veteran Affairs New Clinical Initiative Program grant, as well as through a National Institute on Aging grant.

Study Authors
Bruce Leff, MD, The Johns Hopkins University Schools of Medicine, Johns Hopkins Bayview Medical Center and The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Lynda Burton, ScD, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 
Scott L. Mader, MD, Portland Veterans Affairs Medical Center, Portland, OR, Oregon Health and Science University, Portland, OR 
Bruce Naughton, MD, State University of New York, Independent Health, Univera Health, Buffalo, NY 
Jeffrey Burl, MD, Fallon Community Health Plan and Fallon Clinic, Worcester, MA
Sharon K. Inouye, MD, MPH, Harvard Medical School, Boston, MA 
William B. Greenough III, MD, The Johns Hopkins University Schools of Medicine, Johns Hopkins Bayview Medical Center and The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Susan Guido, RN, The Johns Hopkins University Schools of Medicine, Johns Hopkins Bayview Medical Center
Christopher Langston, PhD, The John A. Hartford Foundation, New York, NY 
Kevin D. Frick, PhD, The Johns Hopkins University Schools of Medicine, Johns Hopkins Bayview Medical Center and The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Donald Steinwachs, PhD, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
John R. Burton, MD, The Johns Hopkins University Schools of Medicine, Johns Hopkins Bayview Medical Center

Portions of this work have been presented at meetings of the American Geriatrics Society, May 2001, 2003, 2004, the Gerontological Society of America, November 2002, November 2003, and the American Academy of Home Care Physicians, May 2005.