Home or Hospital? Comparing Outcomes of Hospital-at-Home and Inpatient Ward Care

Background

Hospital-at-Home (HaH) programmes provide acute care to selected patients in their homes as an alternative to internal medicine ward hospitalisation (IMWH). Although implemented globally for over two decades, evidence on their safety and effectiveness across diverse healthcare systems remains limited. With health systems facing rising workloads, workforce burnout, and a widening gap between population growth and hospital bed availability, HaH represents a potentially valuable solution. This study aimed to compare quality of care and clinical outcomes of HaH versus standard IMWH.

Methods

A single-institution retrospective cohort study with a nested paired case-control analysis was conducted at Rambam Health Care Campus, Israel. Patients hospitalised between November 2020 and August 2023 with diagnoses eligible for HaH were included. HaH patients were matched 1:4 to IMWH patients by diagnosis, age, and sex. Subgroup analyses were performed for pneumonia, cellulitis, and urinary tract infection (UTI). Primary outcomes were length of stay (LOS), in-hospital mortality, 7- and 30-day post-discharge mortality, and 30-day readmissions and ER visits.

Results

Of 10,632 patients, 212 received HaH care. Across all indications, HaH was associated with significantly better or comparable outcomes: LOS shorter by 1.64 days (P < 0.001), 54% reduction in 30-day mortality (OR = 0.46, P = 0.006), and 70% reduction in 7-day mortality (OR = 0.30, P = 0.003). Among pneumonia patients, effects were more pronounced: LOS shorter by 2.15 days (P = 0.004), 77% reduction in 30-day mortality (OR = 0.23, P = 0.008), and 85% reduction in 7-day mortality (OR = 0.15, P = 0.009). Nested analyses confirmed these trends.

Conclusions

With careful patient selection, HaH was at least non-inferior to conventional inpatient care, reducing LOS and short-term mortality while maintaining safety. HaH offers a viable strategy to alleviate overcrowding in internal medicine wards.

Key messages

• Hospital-at-Home is a safe and effective alternative to conventional inpatient care for carefully selected patients, achieving better clinical outcomes without increasing readmission rates.

• Scaling Hospital-at-Home programmes offers health systems a practical strategy to ease internal medicine ward overcrowding and address growing pressures on hospital bed capacity.