For acutely ill adult patients, does care in the comfort of home deliver the same outcomes as hospital care? That was the essential question of a recent Brigham and Women’s Hospital (BWH) pilot study, the first randomized, controlled clinical trial in the United States to test the impact of home-based hospital care on care quality, safety, and costs.
The study, supported by the Partners HealthCare Center for Population Health and the BWH BRIght Futures Prize, explored the effects of home care on 20 adult patients with infection, heart failure, chronic obstructive pulmonary disease, or asthma admitted to the emergency department. While 11 of the patients received hospital-based care, nine received home hospital care including in-home visits from care providers, 24-hour physician coverage, remote monitoring via video, and texting with providers. Via patient interviews, the investigators uncovered a wide range of benefits associated with home-based care, including decreased utilization, improved physical activity, and cost reductions of up to half as compared with hospital-based care.
In addition to enhancing patient satisfaction by delivering care in a more patient-centered manner, home-based care can avoid unintended consequences of hospital care such as hospital-acquired infection and readmission. Based on the initial study results, David Levine, MD, MPH, MA, study lead author and physician and researcher in BWH’s Division of General Internal Medicine and Primary Care, is conducting a larger scale trial to demonstrate the home-based care outcomes in a larger group of patients.
“We haven't dramatically changed the way we've taken care of acutely ill patients in this country for almost a century," says Dr. Levine. “Being able to shift the site of care is a powerful way to change how we care for acutely ill patients, and we’re studying with scientific rigor whether the home hospital model can help us provide care in a more patient-centered manner.”
This innovative home-based health care program was recently put on the national stage in a CBS Evening News story profiling Phyllis Petruzelli, who received care for pneumonia in the comfort of her own home. Her vital signs were remotely monitored by a skin patch, which allowed her care team to track her mobility and number of steps taken each day; data from this trial indicated that home patients walk 10 times more than hospitalized individuals. Following her treatment, Petruzelli related her positive experience: “I think that’s why I healed so fast, because I’m moving more.”
Read more about the program and Petruzelli’s experience here.
Image credit: CBS News