CELEBRATING THIRTY YEARS OF AGING
AND HEALTH 2012 ANNUAL REPORT
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INNOVATIVE MODELS OF CARE

1983

Hospital at Home

1995-2011 Recognizing that the hospital is a dangerous setting for frail older adults, the Hartford Foundation worked with John R. Burton, MD, and Bruce Leff, MD, at Johns Hopkins University School of Medicine on the Hospital at Home initiative. Instead of admitting a patient to the hospital, physicians, nurses and other supportstaff bring their services, along with equipment and other technologies, to the patient’s home.

With $6 million in funding from the Hartford Foundation, the theoretical framework and clinical protocols for Hospital at Home were developed, followed by a pilot study and a national demonstration study. Four conditions (pneumonia, congestive heart failure, pulmonary disease, and deep skin infection) were shown to be treatable outside the hospital while saving money.

Even with the demonstrated advantages, the Hospital at Home concept was not readily accepted. But over the past decade the concept has gained considerable traction. In 2004, the Hartford Foundation provided a six-year grant of $1.6 million for wider dissemination. Six Veterans Affairs medical centers implemented the program and in 2009, the project shifted to a licensing and consultation model to support its spread.

After a 2012 Health Affairs article showing that Hospital at Home in New Mexico achieved outcomes equal to or better than regular hospital care, but with 19 percent lower costs, public and media interest spiked. New penalties and incentives in the Affordable Care Act are also driving renewed attention to the model.

(Top and Below) Hospital at Home, in which certain acutely ill older patients receive care at home rather than in a hospital, was tested at several sites including the Portland Oregon VA Medical Center. Based on the positive results of the study, the Portland VA continues to offer Hospital at Home. Doctors, nurses, and other health care professionals bring their services along with necessary equipment into the homes of patients. When we first conceived of the Hospital at Home model, hospitals were thought of as the only place very sick people could get care. This was before the Institute of Medicine focused on patient safety. If you proposed caring for acutely ill older adults outside of the hospital you were thought to be crazy.” Bruce Leff, MD
Associate Professor of Medicine
Division of Geriatric Medicine and Gerontology
Johns Hopkins University

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