We are unofficially declaring this “Hospital at Home Week.” Health care journalist Judith Graham coincidentally kicked off the festivities last week with an excellent story on the Hospital at Home model in Kaiser Health News, subsequently picked up by USA Today. And today, we celebrate publication of a paper in Health Affairs showing that Hospital at Home achieved equal or better outcomes as regular hospital care—but with 19 percent lower costs.
Among the authors on the paper is Bruce Leff, principal investigator on the $1.6 million, six-year grant we gave to him and his team at Johns Hopkins in 2005 to disseminate their home hospital program. We thought it was a terrific idea; hospitals can be dangerous for older adults. They often return home from the hospital more frail than they entered as a result of complications like infections, delirium, or medication mix-ups due to poorly managed care transitions. Plus, hospital care is unnecessarily expensive. By admitting older adults who meet certain criteria and have specific illnesses, such as congestive heart failure, chronic obstructive pulmonary disease, pneumonia, and dehydration, among others, Hospital at Home is able to deliver excellent hospital-level care for older patients in the home by providing appropriate equipment as well as daily visits from a doctor and nurse.
We are pleased to see that the cost-effective model, first piloted with Hartford funding in 1995, is gaining considerable traction. The Health Affairs piece highlights new or expanded adoption efforts in partnership with United Health, the Veterans Administration, and venture capital firms. But the biggest effort to spread the model comes from the federal government; the Medicare Independence at Home demonstration, funded under the Affordable Care Act, launched 16 sites incorporating core elements of Hospital at Home that can be applied to home-based primary care for patients with multiple chronic conditions.
The rest of the June Health Affairs issue is of interest to us and our readers as well. Sponsored by the SCAN Foundation, the themed issue focuses on topics particularly relevant to elderly and disabled patients, such as coordination of care, care delivery innovations, and improved end-of-life care. Bruce Leff has a second paper in the issue, about a collaborative known as the Medicare Innovations Collaborative (Med-IC). Med-IC seeks to advocate and effect changes in health care policy by focusing on efforts to improve health care delivery. Six sites with a proven track record for excellent geriatric care were selected to act as learning laboratories to test the feasibility of a “geriatric portfolio” care model. This includes using established geriatric assessment tools and quality improvement; palliative care; a national program to improve elder care and nurse competence; strong transitional care; and Hospital at Home.
We congratulate Bruce Leff, his fellow investigators, and all the researchers contributing to improvements in the care of older adults in this issue of Health Affairs. We look forward to hearing about further successes with Hospital at Home, and hope that someday older adults throughout the United States will have the option to stay home while receiving high-quality hospital care.