A Multidisciplinary Hospital-at-Home Program in a Tertiary Singapore Hospital: A Comparative Study.

Abstract

Hospital-at-home (HaH) is an alternative care model that delivers acute, inpatient-level care in patients' homes and is well-established in Western countries. Given the unique challenges facing Asian healthcare systems, there is a need to evaluate the impact of HaH in this context. We conducted a retrospective analysis comparing a HaH program with conventional inpatient care at a tertiary hospital in Singapore. The intervention group received hospital-level care at home. Outcomes measured include total and in-hospital length of stay (LOS), mortality, cost, and readmission, and emergency department (ED) visits within 30 and 90 days post discharge. In total, 143 HaH patients and 147 control patients were included in the study. HaH patients showed significantly shorter in-hospital LOS (-40%, 5 days) despite longer total LOS (+ 28%, 2 days) compared to usual care. No increase in mortality was observed in the HaH group. There was no significant difference between groups in terms of 30- and 90-day post-discharge urgent readmissions (IRR 1.16, 95% CI 0.73-1.84 and IRR 1.21, 95% CI 0.83-1.78 respectively) or 30-day post-discharge ED visits (IRR 3.16, 95% CI 0.77-13.03). However, HaH patients were 78 percentage points less likely to have no ED visits in the 90 days after discharge (95% CI, -113.22 to -43.57). Cost of care remained comparable between groups (cost ratio 1.06, 95% CI 0.82-1.41). HaH care in an Asian tertiary hospital setting was associated with shorter in-hospital LOS, comparable mortality, readmission rates, and overall cost compared to usual care, but a higher likelihood of post-discharge ED utilization. Overall, these findings support the feasibility of HaH in similar settings, providing evidence to guide policymakers in adopting home-based acute care.