Older patients receiving care through hospital-at-home programs across the United States experienced low mortality rates, Mass General Brigham researchers found.
Researchers from the Boston-based health system, which operates one of the country's largest acute-care-at-home programs, examined billing records for all 5,132 Medicare fee-for-service patients enrolled in more than 300 hospital-at-home programs between July 1, 2022 and June 30, 2023. Their research letter, published Monday in the Annals of Internal Medicine, found 0.5% of the patients died while receiving acute-level care at home, and 6.2% returned to brick-and-mortar hospitals for at least one overnight stay while enrolled in the program.
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The researchers did not compare mortality and readmission rates with those of patients being treated in hospitals because the study was observational, according to lead author Dr. David Levine. Additional research is needed to compare at-home patient outcomes with those at brick-and-mortar hospitals, he said.
Acute-care-at-home programs typically screen patients for suitability; brick-and-mortar hospitals generally treat a wider variety of conditions.
The researchers' results are consistent with a larger study published in JAMA Health Forum in November. It found mortality and rehospitalization rates of 0.3% and 7.2%, respectively, among more than 11,000 patients enrolled in hospital-at-home programs around the country between Nov. 25, 2021, and March 20, 2023.
Data from both studies could be used as “talking points” in support of the Centers for Medicare and Medicaid Services' Acute Hospital Care at Home waiver program, set to expire at the end of the year, said Levine, the clinical director for research and development for Mass General Brigham Healthcare at Home.
CMS launched the waiver—under which it reimburses hospitals at the same rate for home-based care as it does for in-facility care—in 2020 to help free up beds during the COVID-19 pandemic. The agency is gathering comments about the efficacy and equity of the model, with Congress expected to decide in the fall if the waiver will be extended, made permanent or terminated.
Monday's study offered insights on the demographics of Medicare fee-for-service patients receiving acute care at home. Nearly 42% were at least 80 years old, and almost half had diabetes and other chronic illnesses, such as heart disease.
Approximately 85% of the hospital-at-home participants in the study were white, which Levine attributed to the population makeup of Medicare fee-for-service plans. Black and Hispanic hospital-at-home patients had lower mortality rates, at 0.2%, than the overall population.
Less than 2% of the patients included in the study lived in rural communities. Levine said the study's findings could encourage more rural facilities to offer hospital-at-home care, pointing to the dearth of rural hospitals that do so.
“This [research] speaks volumes to the type of care the model can deliver and that many patients can do well when they go home with this care model," Levine said.
Despite uncertainty over hospital-at-home's future, many hospitals have placed big bets on the programs. Mass General Brigham announced plans in 2022 to expand its hospital-at-home program from 30 beds per day to 200 within a few years.
