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Perspective US Health Care Reform Health Care Practice / Quality
Kushal T. Kadakia
Celynne A. Balatbat
Albert L. Siu
I. Glenn Cohen
Consuelo H. Wilkins
Victor J. Dzau
Anaeze C. Offodile
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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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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.