The Prognosis and Outcomes of Acutely Ill Patients Admitted to “Hospital-at-home” Programs Versus Patients with Similar Attributes Admitted to Internal Hospital Wards

Abstract

Hospital-at-home programs have shown clinical and economic benefits globally but are still in the early stages in Israel for acute care. This study evaluated hospital-at-home units’ clinical, safety, and economic outcomes compared to internal wards. The study assesses hospital-at-home units’ clinical, safety, and economic outcomes versus internal wards for acutely ill patients. This retrospective matched cohort study assessed the impact of at-home hospitalization on patient survival. Patients admitted from the emergency room to at-home hospitalization were matched 2:1 with patients admitted to internal wards based on demographic and clinical characteristics using propensity score matching. The primary outcome was the rate of readmissions at 30 days. After matching, 645 individuals were included: 215 in the hospital-at-home group and 430 in the control group. Baseline characteristics were well-balanced. After 30 days, 6 individuals in the study group and 38 in the control group had died. The study group’s overall mortality rate was significantly lower (2.79% vs 8.84%, p = .0043). The hazard ratio for the control group compared to the study group was 1.907 (95% CI 1.227-2.963), indicating a 90% increased risk of death. The primary outcome of readmissions at 30 days did not differ significantly between groups. Secondary outcomes showed substantially lower healthcare resource use in the study group. Hospital-at-home units are a safe alternative to internal wards, offering significant mortality risk reduction and lower healthcare resource use. These findings support the feasibility of implementing hospital-at-home units for acute care in Israel.