July 12, 2018
A safe and effective alternative to inpatient care for older adults—which was associated with better patient outcomes and ratings of care—is hospital-at-home (HaH) care bundled with a 30-day episode of postacute transitional care, according to a recent study published online in JAMA Internal Medicine.
HaH care provides acute hospital-level care in a patient’s home as a substitute for traditional inpatient care. Notably, in September of 2017 the Physician-Focused Payment Model Technical Advisory Committee recommended the implementation of an alternative payment model for a new model of HaH that bundles the acute episode with 30 days of postacute transitional care.
In order to understand and report on the outcomes of the new payment model for HaH care, the research team, led by Alex D Federman, MD, MPH, Icahn School of Medicine at Mount Sinai (New York, NY), and colleagues, conducted a case-control study of HaH care patients with a concurrent control group of hospital inpatients who were recruited from emergency departments (EDs). The participants of the study had fee-for-service Medicare and acute medical illness requiring inpatient-level care. They were then compared with the control patients who met HaH eligibility but refused participation or were seen in the ED when they were not able to initiate HaH admission.
The primary outcomes of the study included:
- acute period length of stay (LOS);
- all-cause 30-day hospital readmissions and ED visits;
- admissions to skilled nursing facilities (SNFs);
- referral to a certified home health care agency; and
- patient experiences with care.
The research team assessed the data on all patients 30 days postdischarge, which included 507 study participants (average age 74.6 years). The researchers determined that the 295 HaH patients, who were older than the 212 controls, were more likely to have a pre-acute functional impairment. They also found that HaH patients had shorter LOS; lower rates of readmissions, ED revisits and SNF admissions; and were also more likely to rate their hospital care highly. The researchers reported no differences in referrals to certified home health agencies.
“HaH care bundled with a 30-day postacute transitional care episode was associated with better patient outcomes and ratings of care compared with inpatient hospitalization,” Dr Federman and colleagues concluded in the study. “This model warrants consideration for addition to Medicare’s current portfolio of shared savings programs.”
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