Hospital-at-Home: Multistakeholder Considerations for Program Dissemination and Scale

In 2019, US hospitals accounted for 36 million admissions and $1.2 trillion in spending (31% of national health expenditures).¹ Acutely ill older adults, specifically Medicare Part A enrollees with chronic diseases, accounted for 10.5 million discharges in 2019.^{2, 3} Inpatient care, however, is characterized by inefficiencies, as articulated in the Institute of Medicine’s report, Crossing the Quality Chasm.⁴ Research has also identified “post-hospitalization syndrome,” which encompasses physical decline (e.g., decreased mobility), mental complications (e.g., delirium), and an increased risk of 30-day readmissions, all of which are attributable to the allostatic stress of facility-based care.^{5, 6} These gaps in care access and quality are amplified when examined through an equity lens, with disparate outcomes in readmissions, morbidity, chronic disease management, and overall health among racial minorities.⁷

Nevertheless, population aging is expected to intensify the utilization of hospital services. This and the gaps in hospital quality exposed by the COVID-19 pandemic highlight the need to redesign acute care to better serve older adults and minorities. Consequently, the National Academy of Medicine (NAM) convened a multistakeholder meeting to discuss the post-pandemic future of acute care, with a particular focus on Hospital-at-Home (HaH) as an alternative to facility-based approaches. The meeting’s objectives were to (1) define the current scope of HaH care models, (2) create a shared understanding across stakeholders of the priority areas and challenges for HaH, and (3) identify sector-specific levers to maximize HaH’s benefits and scalability.

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References

1. Centers for Medicare & Medicaid Services. National health expenditures fact sheet. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet. Accessed October 1, 2021.
2. Agency for Healthcare Research and Quality. Most common diagnoses for inpatient stays. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb277-Top-Reasons-Hospital-Stays-2018.pdf. Accessed August 31, 2022.
3. Centers for Medicare & Medicaid Services. All Medicare inpatient hospitals: utilization, program payments, and cost sharing for original Medicare beneficiaries, by type of entitlement, calendar years 2014–2019. https://www.cms.gov/files/document/2019cpsmdcrinpthosp1.pdf. Accessed October 1, 2021.
4. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.
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7. Fiscella K, Sanders MR. Racial and ethnic disparities in the quality of health care. Annu Rev Public Health. 2016; 37(1): 375- 94.