Can a patient receive high-quality, hospital level care in the comfort of their own living room? A recent pilot study from Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital (BWFH) was designed to deliver evidence to answer that question.
The Home Hospital project, led by David Levine, MD, MA, a physician and researcher in the Brigham’s Division of General Internal Medicine and Primary Care, and co-principal investigator Jeff Schnipper, MD, MPH, sought to compare the cost, quality, safety, and experience of hospital-level care at home to traditional hospitalization. Twenty-one adult patients opted into the randomized, controlled trial via admittable visits to the Brigham or BWFH emergency departments, for a wide range of conditions: infections, heart failure, breathing problems. Once enrolled, they were randomly selected for either home hospital or traditional hospital care.
At home, patients received care from home hospital physicians and nurses, benefitting from state-of-the-art technology, including a remote vital-sign monitoring device that enabled their doctor or nurse to check their heart rate and other vitals with a skin patch. The team also monitored patient activity and tracked sleep, to test its hypothesis that patients move and sleep more while at home. All of the patients were given an electronic tablet that allowed them to directly and confidentially communicate with their team via phone, text and video at any time of day.
“For over a decade, the home hospital model has been practiced in Europe and Australia, where patients have experienced the same level of safety and quality compared to traditional hospital stays, in addition to improved patient experience and reduced costs,” says Dr. Levine. “But this model has rarely been tried or rigorously tested in the U.S.”
Data collected from the pilot shows that home hospital care lowered costs, improved patient experience, maintained quality and safety, and improved sleep and activity. While Dr. Levine notes that some procedures will always need to be performed in a hospital setting, home may be the best place for some patients to receive care, monitoring, and treatment. The pilot was a first step in testing this model; Dr. Levine was awarded the Brigham Research Institute’s $100,000 BRIght Futures Prize for the project, which will enable him to expand the pilot through this year and further study its outcomes.
“We believe receiving care at home puts the patient first, improves patient experience and reduces costs,” Levine said. “Patients can sleep in their own bed, eat their own food and spend more time with family and friends. For many conditions, a home hospital will transform our concept of safe, high-quality and cost-effective care.”
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