It's long been known that hospitalization can be tough on the elderly. Frail or chronically ill patients can pick up secondary infections, lose functionality or become anxious and confused by the unfamiliar environment.
But new research released by Johns Hopkins Medicine--the parent organization of the Baltimore-based hospital, system and medical school--suggests that many of these patients could be treated just as safely and effectively in the comfort of their own homes, if not more so. And the at-home care may turn out to be cheaper than in-hospital care, the researchers authoring the study found.
The study, published Dec. 6 in the Annals of Internal Medicine, found that providing acute, hospital-level care to elderly patients in their homes resulted in comparable or better treatment outcomes, higher patient satisfaction and lower costs than traditional hospitalization for some serious illnesses.
Johns Hopkins has been developing a hospital-at-home model since 1994 under a grant from the John A. Hartford Foundation, a philanthropy focused on improving healthcare for seniors. Its study evaluated hospital-at-home programs run by the Portland (Ore.) VA Medical Center; Fallon Community Health Plan of Worcester, Mass.; and a collaboration between Univera Healthcare and Independent Health Association, both in Buffalo, N.Y.
Home-based hospital care could prove a viable treatment alternative in coming years as the aging population threatens to strain future hospital capacity, said Bruce Leff, an associate professor at Johns Hopkins University School of Medicine and the study's principal investigator. According to the Census Bureau, the number of Americans age 65 or older is expected to climb 74% to 62.6 million over the next 25 years.
"Unless we're going to keep building lots and lots of new beds, there needs to be a way to provide care to the aging population outside the bricks and mortar of the hospital setting," said Leff, a geriatrician.
The two-part study focused on patients age 65 or older who required acute care for one of four conditions--pneumonia, chronic heart failure, chronic obstructive pulmonary disease or soft-tissue inflammation.
In the first phase, 289 patients were treated at hospitals from November 2000 to September 2001. In the second phase, from November 2001 to September 2002 and including 169 patients, 141 were allowed to choose between being admitted to a hospital or receiving hospital-at-home care, which consisted of around-the-clock nursing supervision and daily visits from a physician. Patients in the latter group received all tests and treatments, such as electrocardiograms, oxygen therapy and intravenous antibiotics, at home as needed. Eighty-four patients, or 60% of those allowed a choice in the second phase, chose hospital-at-home care.
According to the study, standards of care were met equally in both groups, yet patients in the hospital-at-home program required fewer interventions, such as intravenous fluids or urinary catheters. They also had shorter recovery times, requiring an average of 3.2 days of care compared with 4.9 days among patients in the hospital. As a result, treatment costs averaged $5,081 for home-treated patients vs. $7,480 for hospitalized patients.
In addition, none of the patients in the hospital-at-home program died or suffered serious complications, while 3% and 6% of hospitalized patients died and experienced complications, respectively.
Still, the benefits of hospital-at-home care remain far from certain. Researchers admitted that the nonrandom study, or "quasi-experiment," had several limitations, including a small sample size and potential selection bias. A similar study in Great Britain conducted in 1998 by Oxford University found that hospital-at-home care actually increased costs for patients with chronic obstructive airway disease and for those recovering from a hysterectomy.
Still, the Portland VA center has continued to see such positive results from hospital-at-home care that it has expanded its program to include adult patients of all ages as well as those discharged early, said Scott Mader, clinical director of the 221-bed hospital's rehabilitation and long-term-care division.