Hospital-Level Care at Home for Adults with Acute Respiratory Illness: A Descriptive Analysis

ABSTRACT

Rationale “Home hospital” is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite years of successful operations and evidence from randomized controlled trials, to our knowledge outcomes in the U.S. specifically for patients with respiratory disease have not been evaluated. Methods We performed a retrospective evaluation of all patients who were cared for in our home hospital program between 2016 and 2021. We compared patients requiring admission with respiratory disease (asthma exacerbation, COPD exacerbation, and any non-COVID pneumonia) to all other patients who received home hospital care (other general medical conditions such as heart failure and infectious processes). Patients entered the program either from the emergency department after it was determined they required admission or from the general medical ward after it was determined they required additional days of acute care. Patients were risk-stratified using peak flow (asthma), BAP-65 (COPD), and CURB- 65 (pneumonia), among other scores to prognosticate against the ICU. Upon admission at home, patients received 2 nurse/paramedic visits daily, 1 physician visit daily, IV medications, advanced respiratory therapies, continuous heart and respiratory rate monitoring, and other hospital-level treatments/diagnostics as needed. Results Among 1,166 admissions, 25% were for respiratory disease (38% COPD, 38% pneumonia, and 24% asthma) and 75% were for non-respiratory disease (48% infection, 27% heart failure). Both groups had similar sociodemographic characteristics mean age 72 years (SD, 17), 63% female, 44% White, 39% partnered, 71% English-speaking, 52% Medicare beneficiary, and 58% retired. Groups differed by education, with less attainment in the respiratory group (34% high school vs 29%;p=0.034), smoking status (20% active smoker vs 9%;p<0.001), and more outpatient medications (median number, 10 vs 8;p<0.001). During home hospital, respiratory patients had less utilization length of stay (mean days, 3.4 vs 4.8;p<0.001), laboratory orders (median, 0 vs 2;p<0.001), consultations (1% vs 7%;p=0.004), and physical/occupational therapy (2% vs 7%;p=0.032). Both groups had a similar escalation rate (i.e., requiring transfer back to the hospital) of 4% and no mortality during home hospital. Within 30-days of discharge, both groups were similar 14% readmission, 9% ED presentation, and 4% mortality. Conclusions Home hospital care is safe and effective for patients with acute respiratory illness compared to other general medical conditions. If scaled, it can serve to generate significant high-value capacity creation for health systems and communities, with opportunities to advance the complexity of care delivered.