Safety in a hybrid hospital-at-home program versus traditional inpatient care: A pragmatic randomized controlled trial.
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| Titel: | Safety in a hybrid hospital-at-home program versus traditional inpatient care: A pragmatic randomized controlled trial. |
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| Autoren: | Maniaci MJ; Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA., Sangaralingham LR; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Behnken EM; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Hart MS; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Inselman SA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Paulson M; Division of Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA., Nelson CR; Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA., Gothot RA; Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA., Chang YH; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA., Hanson KT; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Larson Smith YM; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Oloyede SV; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Gifford SL; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Taylor JD; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Dunn AN; Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA., Dunlay SM; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Dowdy SC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Habermann EB; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Bosch W; Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA., Cowart JB; Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA., Yao X; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. |
| Quelle: | Journal of hospital medicine [J Hosp Med] 2025 Nov; Vol. 20 (11), pp. 1174-1184. Date of Electronic Publication: 2025 May 21. |
| Publikationsart: | Journal Article; Pragmatic Clinical Trial; Randomized Controlled Trial; Multicenter Study |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Wiley Country of Publication: United States NLM ID: 101271025 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1553-5606 (Electronic) Linking ISSN: 15535592 NLM ISO Abbreviation: J Hosp Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2022- : Hoboken, NJ : Wiley Original Publication: Hoboken, NJ : John Wiley & Sons, 2006- |
| MeSH-Schlagworte: | Home Care Services, Hospital-Based*/standards , Patient Safety* , Inpatients* , Home Care Services*, Humans ; Female ; Male ; Aged ; Middle Aged ; Patient Readmission/statistics & numerical data ; United States ; Hospitalization ; Aged, 80 and over |
| Abstract: | Background: Hospital-at-home programs (HaH) in the United States have evolved to include a virtual-hybrid delivery model, where all physician encounters are virtual and partnered with a home care team. Objective: To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick-and-mortar (B&M) hospital care. Methods: We conducted a pragmatic trial at three hospitals, randomizing 1150 acutely ill patients requiring hospital care between July 10, 2023, and October 31, 2023 one-to-one into two groups: intervention (HaH) and control (B&M). The primary analysis was an intention-to-treat non-inferiority analysis of the primary outcome, which was a composite of 30-day all-cause mortality and unplanned readmissions. Secondary outcomes included 30-day readmission, all-cause mortality, and patient experience. Results: The mean age was 67.8 (standard deviation [SD] 16.3) years, and 52.2% were female. The primary outcome occurred in 99 (17.3%) HaH patients and 114 (19.8%) B&M patients (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.63-1.14, p = .28), meeting the non-inferiority criterion. Thirty-day unplanned readmission occurred in 84 (14.7%) HaH patients and 101 (17.5%) B&M patients (OR 0.81, 95% CI 0.59-1.11, p = .19). Thirty-day all-cause mortality occurred in 25 (4.4%) HaH patients and 19 (3.3%) B&M patients (OR 1.34, 95% CI 0.73-2.46, p = .35). No HaH patients died while receiving their hospital care at home. HaH program was associated with a higher likelihood of patients reporting feeling extremely comfortable or very comfortable (84.4% HaH; 60.9% B&M, p = .001). Conclusion: A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care. (© 2025 Society of Hospital Medicine.) |
| References: | Jernigan JA, Hatfield KM, Wolford H, et al. Multidrug‐resistant bacterial infections in U.S. hospitalized patients, 2012‐2017. N Engl J Med. 2020;382(14):1309‐1319. Klevens RM, Edwards JR, Richards, Jr. CL, et al. Estimating health care‐associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160‐166. Loyd C, Markland AD, Zhang Y, et al. Prevalence of hospital‐associated disability in older adults: ameta‐analysis. J Am Med Dir Assoc. 2020;21(4):455‐461.e5. CMS.gov. Acute hospital care at home. CMS QualityNet. 2022. Accessed October 31, 2024. https://qualitynet.cms.gov/acute-hospital-care-at-home. Levine DM, Souza J, Schnipper JL, Tsai TC, Leff B, Landon BE. Acute hospital care at home in the United States: the early national experience. Ann Intern Med. 2024;177(1):109‐110. Paulson MR, Shulman EP, Dunn AN, et al. Implementation of a virtual and in‐person hybrid hospital‐at‐home model in two geographically separate regions utilizing a single command center: a descriptive cohort study. BMC Health Serv Res. 2023;23(1):139. Arsenault‐Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. Hospital‐at‐home interventions vs in‐hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta‐analysis. JAMA Netw Open. 2021;4(6):e2111568. Yao X, Paulson M, Maniaci MJ, et al. Effect of hospital‐at‐home vs. traditional brick‐and‐mortar hospital care in acutely ill adults: study protocol for a pragmatic randomized controlled trial. Trials. 2022;23(1):503. Levine DM, Paz M, Burke K, et al. Remote vs in‐home physician visits for hospital‐level care at home: a randomized clinical trial. JAMA Netw Open. 2022;5(8):e2229067. Elfghi M, Jordan F, Sultan S, Tawfick W. Study within a trial protocol: same‐day consent vs. delayed consent in a randomized trial. J Evid Based Med. 2020;13(3):246‐248. NICE‐SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283‐1297. Offerman SR, Nishijima DK, Ballard DW, Chetipally UK, Vinson DR, Holmes JF. The use of delayed telephone informed consent for observational emergency medicine research is ethical and effective. Acad Emerg Med. 2013;20(4):403‐407. Jenkinson C. The Picker Patient Experience Questionnaire: development and validation using data from in‐patient surveys in five countries. Int J Qual Health Care. 2002;14(5):353‐358. Li F, Morgan KL, Zaslavsky AM. Balancing covariates via propensity score weighting. J Am Stat Assoc. 2018;113(521):390‐400. Augustine MR, Siu AL, Boockvar KS, DeCherrie LV, Leff BA, Federman AD. Outcomes of hospital at home for older adults with and without high levels of social support. Home Healthc Now. 2021;39(5):261‐270. Caplan GA, Sulaiman NS, Mangin DA, Aimonino Ricauda N, Wilson AD, Barclay L. A meta‐analysis of “hospital in the home”. Med J Aust. 2012;197(9):512‐519. Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital‐level care at home for acutely ill older patients. Ann Intern Med. 2005;143(11):798‐808. Levine DM, Ouchi K, Blanchfield B, et al. Hospital‐level care at home for acutely ill adults. Ann Intern Med. 2020;172(2):77‐85. Saenger P, Federman AD, DeCherrie LV, et al. Choosing inpatient vs home treatment: why patients accept or decline hospital at home. J Am Geriatr Soc. 2020;68(7):1579‐1583. Yeh RW, Valsdottir LR, Yeh MW, et al. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ. 2018;363:k5094. |
| Grant Information: | Mayo Clinic |
| Entry Date(s): | Date Created: 20250522 Date Completed: 20251102 Latest Revision: 20251201 |
| Update Code: | 20251201 |
| DOI: | 10.1002/jhm.70076 |
| PMID: | 40400147 |
| Datenbank: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstract: | Background: Hospital-at-home programs (HaH) in the United States have evolved to include a virtual-hybrid delivery model, where all physician encounters are virtual and partnered with a home care team.<br />Objective: To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick-and-mortar (B&M) hospital care.<br />Methods: We conducted a pragmatic trial at three hospitals, randomizing 1150 acutely ill patients requiring hospital care between July 10, 2023, and October 31, 2023 one-to-one into two groups: intervention (HaH) and control (B&M). The primary analysis was an intention-to-treat non-inferiority analysis of the primary outcome, which was a composite of 30-day all-cause mortality and unplanned readmissions. Secondary outcomes included 30-day readmission, all-cause mortality, and patient experience.<br />Results: The mean age was 67.8 (standard deviation [SD] 16.3) years, and 52.2% were female. The primary outcome occurred in 99 (17.3%) HaH patients and 114 (19.8%) B&M patients (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.63-1.14, p = .28), meeting the non-inferiority criterion. Thirty-day unplanned readmission occurred in 84 (14.7%) HaH patients and 101 (17.5%) B&M patients (OR 0.81, 95% CI 0.59-1.11, p = .19). Thirty-day all-cause mortality occurred in 25 (4.4%) HaH patients and 19 (3.3%) B&M patients (OR 1.34, 95% CI 0.73-2.46, p = .35). No HaH patients died while receiving their hospital care at home. HaH program was associated with a higher likelihood of patients reporting feeling extremely comfortable or very comfortable (84.4% HaH; 60.9% B&M, p = .001).<br />Conclusion: A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care.<br /> (© 2025 Society of Hospital Medicine.) |
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| ISSN: | 1553-5606 |
| DOI: | 10.1002/jhm.70076 |