Home care for acutely ill patients reduces cost, increases physical activity

Substitutive hospital-level care at home for acutely ill adults is associated with lower cost, healthcare use and readmissions and with greater physical activity compared with usual hospital care, as shown in a recent study.

Home patients had a 38-percent (95 percent confidence interval, 24–49 percent) lower adjusted mean cost of the acute care episode than control patients. Home patients, compared with those who received usual care, also had fewer laboratory orders (median per admission, 3 vs 15), imaging studies (median, 14 percent vs 44 percent) and consultations (median, 2 percent vs 31 percent).

In addition, home care led to increased physical activity, with patients spending a smaller proportion of the day sedentary (median, 12 percent vs 23 percent) or lying down (median, 18 percent vs 55 percent). They were also readmitted less frequently within 30 days (7 percent vs 23 percent).

This randomized controlled trial at an academic medical centre and community hospital included 91 adults (43 home and 48 control) admitted via the emergency department with selected acute conditions. Acute care at home involved nurse and physician home visits, intravenous medications, remote monitoring, video communication and point-of-care testing.

The total direct cost of the acute care episode (sum of costs for nonphysician labour, supplies, medications and diagnostic tests) was the primary outcome. Healthcare use and physical activity during the acute care episodes and at 30 days were the secondary outcomes.

Generalizability of the findings could be limited by several factors such as the use of two sites, the small number of home physicians and the small sample of highly selected patients (with a 63-percent refusal rate among potentially eligible patients).