• Carme Hernandez, Ann-Marcia C Tukpah, Henry M Mitchell, Nicole A Rosario, Robert B Boxer, Charles A Morris, Jeffrey L Schnipper, and David M Levine.
• Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA; Home Hospitalization, Medical and Nursing Direction, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
• Chest. 2023 Apr 1; 163 (4): 891901891-901.

BackgroundHome hospital (HH) care is hospital-level substitutive care delivered at home for acutely ill patients who traditionally would be cared for in the hospital. Despite HH care programs operating successfully for years and scientific evidence of similar or better outcomes compared with bricks-and-mortar care, HH care outcomes in the United States for respiratory disease have not been evaluated.Research QuestionDo outcomes differ between patients admitted to HH care with acute respiratory illness vs those with other acute general medical conditions?Study Design And MethodsThis was a retrospective evaluation of prospectively collected data of patients admitted to HH care (2017-2021). We compared patients requiring admission with respiratory disease (asthma exacerbation [26%], acute exacerbation of COPD [33%], and non-COVID-19 pneumonia [41%]) to all other patients admitted to HH care. During HH care, patients received two nurse and one physician visit daily, IV medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. Main outcomes were acute and postacute health care use and safety.ResultsWe analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age, 68 ± 17 years, 62% women, and 48% White. Patients with respiratory disease more often were active smokers (21% vs 9%; P < .001). Eighty percent of patients showed an FEV1 to FVC ratio of ≤ 70; 28% showed a severe or very severe obstructive pattern (n = 118). During HH care, patients with respiratory disease showed less health care use: length of stay (mean, 3.4 vs 4.6 days), laboratory orders (median, 0 vs 2), IV medication (43% vs 73%), and specialist consultation (2% vs 7%; P < .001 for all). Ninety-six percent of patients completed the full admission at home with no mortality in the respiratory group. Within 30 days of discharge, both groups showed similar readmission, ED presentation, and mortality rates.InterpretationHH care is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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