Hospital-at-Home Costs and Outcomes: A Cohort Study

Ilan Yehoshua, Sharon Baruch Gez, Bar Cohen, Beatrice Hemo, Angela Irony, Khaled Abou Houssien, Omri Shental, Limor Adler

Keywords: Home hospitalizations, cellulitis, urinary tract infection, pneumonia

Background:

The challenges posed by increased life expectancy, aging populations, and chronic morbidity have become pressing concerns for healthcare systems globally. Simultaneously, there is a documented reduction in the number of hospital beds, facilities, and resources. Hospital care and services constitute the single most significant expenditure in healthcare and are significantly higher than community healthcare services, where comparable.

Research questions:

This study aims to evaluate and compare health outcomes and costs between home hospitalization and traditional hospitalization for three common diagnoses- cellulitis, urinary tract infection (UTI), and pneumonia.

Method:

In this retrospective cohort study, we followed 1,311 patients in home hospitalization and 992 patients in traditional hospitalization. Patients were hospitalized between 1.01.2019 and 31.12.2020 for cellulitis, UTI, and pneumonia treatment. We evaluated healthcare costs, length of hospitalization, referrals for further medical services, and mortality.

Results:

In this study, we were able to establish that home hospitalization is non-inferior to traditional hospitalization in metrics of mortality, rehospitalizations, and emergency department (ED) referrals for three common diagnoses – cellulitis, pneumonia, and UTI. In terms of hospitalization length, home hospitalizations were shorter for pneumonia and cellulitis compared to traditional hospitalization (5.01 vs. 6.05 days, p-value 0.001 and 5.3 vs. 6.1 days, p-value<0.001, respectively). Likewise, for cellulitis and pneumonia, home-hospitalized patients had fewer ED referrals compared to traditional hospitalization (13.5% vs. 19.8%, p-value 0.002 and 13.7% vs. 24% p-value<0.001, respectively) and lower associated costs (7,366 vs. 11,401 New Israeli Shekel (NIS), p-value 0.001, and 6,869 vs. 11,326 NIS, p-value 0.001).

Conclusions:

home-hospitalization may be a viable and even superior alternative for suitable patients for three common infectious diseases – cellulitis, pneumonia, and UTI – given an appropriate infrastructure.

Points for discussion:

Benefits of home hospitilization compared with traditional hospitalizations.

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