Wyniki leczenia w modelu „szpital w domu” vs tradycyjny pobyt szpitalny

IMPORTANCE: Inpatient care is costly, and an aging population, hospital bed shortages, and practitioner shortages stretch inpatient capacity. Alternative modalities of acute care delivery may support growing demands. OBJECTIVE: To compare outcomes of hospital at home (HaH) vs traditional inpatient hospital admissions and to assess facility-level variability in HaH utilization. DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched, retrospective, comparative effectiveness research study used data for age-qualifying (≥65 years) fee-for-service Medicare beneficiaries admitted from January 1, 2021, through December 1, 2022, within HaH-waivered US hospitals that had 12 or more HaH admissions. Analyses were completed from November 2024 to March 2026. EXPOSURE: HaH vs traditional inpatient hospitalization. MAIN OUTCOMES AND MEASURES: Primary clinical outcomes were in-hospital mortality and hospital readmissions and emergency department (ED) visits within 30 days of index admission discharge. Facility-level characteristics were assessed for facilities that had HaH admissions above and below the median (≥149 admissions). Conditional logistic regression was used for dichotomous outcomes, with adjusted odds ratios (aORs) and 95% CIs reported. Log-transformed linear regression was used for skewed continuous outcomes within matched pairs, with adjusted percentage changes and 95% CIs reported. RESULTS: Among 15 871 Medicare beneficiaries (4174 HaH and 11 697 traditional inpatient admissions), the overall mean (SD) age was 77.4 (8.0) years, and 8396 beneficiaries (56.2%) were female. Of 313 HaH-waivered hospitals, 68 were eligible for inclusion, and 11 hospitals accounted for approximately 50% of all HaH admissions. Compared with traditional inpatient admissions, HaH admissions were associated with lower in-hospital mortality (16 of 4174 admissions [0.4%] vs 423 of 11 697 admissions [3.6%]; aOR, 0.09; 95% CI, 0.06-0.16) and lower ED use within 30 days of discharge (366 of 4174 admissions [8.8%] vs 1164 of 11 697 admissions [10.0%]; aOR, 0.86; 95% CI, 0.76-0.97), with no significant difference in readmissions within 30 days of discharge (490 of 4174 admissions [11.7%] vs 1282 of 11 697 admissions [11.0%]; aOR, 1.07; 95% CI, 0.96-1.20). CONCLUSIONS AND RELEVANCE: In this retrospective comparative effectiveness research study of Medicare beneficiaries, HaH was associated with lower in-hospital mortality and ED use within 30 days of discharge, but not hospital readmissions within 30 days, compared with traditional inpatient care. These findings support HaH as an approach that may maintain similar or better short-term outcomes among appropriately selected patients; future studies should evaluate implementation and equity.