Acute Hospital Care at Home Shows Promise for Medically Complex Patients

MONDAY, Jan. 8, 2024 (HealthDay News) -- A diverse group of medically complex patients receive acute hospital care at home (AHCaH), with low rates of mortality during hospitalization and at 30 days, according to a research letter published online Jan. 9 in the Annals of Internal Medicine.

David M. Levine, M.D., M.P.H., from Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues report on the early national experience of the AHCaH waiver, issued in November 2020, creating a regulatory and payment pathway for hospitals to deliver AHCaH. A total of 5,132 patients with a medical diagnosis who received AHCaH between July 1, 2022, and June 30, 2023, were identified, representing 5,551 admissions.

The researchers found that patients receiving AHCaH were medically complex, with a mean hierarchical condition category score of 3.15; 42.5, 43.3, 22.1, and 16.1 percent had heart failure, chronic obstructive pulmonary disease, cancer, and dementia, respectively. Heart failure, respiratory infection, sepsis, kidney or urinary tract infection, and cellulitis were the five most common discharge diagnoses. The mean length of stay was 6.3 days; the escalation rate was 6.2 percent and the mortality rate was 0.5 percent during hospitalization. At 30 days after discharge, the mortality, skilled nursing facility use, and readmission rates were 3.2, 2.6, and 15.6 percent, respectively.

"Our data provide preliminary evidence on national uptake and suggest that AHCaH is an important care model to manage acute illness, including among socially vulnerable and medically complex patients," the authors write.

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