Home-Based Hospital Care Model Cuts Lab Utilization

Hospital care is notoriously expensive and potentially risky for older adults. There is interest in the home-hospital concept where acute services are provided in a patient's home, with the hope of improving the patient experience and reducing costs, while maintaining quality care.

A small study published in the May issue of the Journal of General Internal Medicine shows early evidence that use of home-hospital care does in fact cut costs, benefits the patient experience, and maintains quality of care. While optimal patient selection is important, the model cuts costs due to decreased utilization of services, including a significant decline in laboratory testing, compared to similar patients cared for in the hospital.

Nine patients were randomized to home hospitalization and 11 to usual hospital care for the treatment of infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma, following an emergency room visit.

The home hospital care intervention included two daily nurse visits, one daily physician home visit, intravenous medications, continuous monitoring for heart rate, respiratory rate, telemetry, movement, falls, and sleep via a small skin patch, video communication, and point-of-care blood testing.

The researchers found that there were no adverse safety events and no transfers back to hospital among home-care patients. For home patients median direct costs were 52 percent lower than for usual care inpatients. Furthermore, for home patients the median direct costs for the acute care plus 30-day post-discharge period was 67 percent lower than for inpatients. Home patients had fewer readmissions, but they also had significantly fewer laboratory tests ordered during the care episode—a median of six versus 19 for inpatients.

David Levine, M.D., the study's lead author, tells DTET that the point-of-care test conducted most frequently in at-home patients was the basic metabolic panel, whereas complete blood counts and metabolic panels were most frequently not ordered, compared to inpatients. He says that lab testing in the home setting was only conducted when it would change clinical management. Levine also credits "a wonderful collaboration" with the laboratory for making home-based care feasible. He said that the hospital laboratory was able to process home hospital lab tests (drawn at nurse and doctor visits) in a timely manner and in multiple locations.

"Reimagining the best place to care for select acutely ill adults holds enormous potential," writes Levine and colleagues from Brigham and Women's Hospital in Boston, Mass. "This differs from most home-based models in its ability to handle high patient acuity and enmesh physician medical decision-making with a patient-tailored care team. Careful patient selection also minimized risk."

Takeaway: Laboratory test utilization is significantly reduced in the home-hospital model. This care model is one the laboratory industry should watch.