Safety in a hybrid hospital-at-home program versus traditional inpatient care: A pragmatic randomized controlled trial.

Abstract

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. To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick-and-mortar (B&M) hospital care. 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. 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). A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care.