Michael J Maniaci, Lindsey R Sangaralingham, Emma M Behnken, Melissa S Hart, Shealeigh A Inselman, Margaret Paulson, Chad R Nelson, Rachel A Gothot, Yu-Hui H Chang, Kristine T Hanson, Yvonne M Larson Smith, Sey V Oloyede, Sarah L Gifford, Josh D Taylor, Ajani N Dunn, Shannon M Dunlay, Sean C Dowdy, Elizabeth B Habermann, Wendelyn Bosch, Jennifer B Cowart, Xiaoxi Yao
{"title":"Safety in a hybrid hospital-at-home program versus traditional inpatient care: A pragmatic randomized controlled trial.","authors":"Michael J Maniaci, Lindsey R Sangaralingham, Emma M Behnken, Melissa S Hart, Shealeigh A Inselman, Margaret Paulson, Chad R Nelson, Rachel A Gothot, Yu-Hui H Chang, Kristine T Hanson, Yvonne M Larson Smith, Sey V Oloyede, Sarah L Gifford, Josh D Taylor, Ajani N Dunn, Shannon M Dunlay, Sean C Dowdy, Elizabeth B Habermann, Wendelyn Bosch, Jennifer B Cowart, Xiaoxi Yao","doi":"10.1002/jhm.70076","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hospital-at-home programs (HaH) in the United States have evolved to include a virtual-hybrid delivery model, where all physician encounters are virtual and partnered with a home care team.</p><p><strong>Objective: </strong>To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick-and-mortar (B&M) hospital care.</p><p><strong>Methods: </strong>We conducted a pragmatic trial at three hospitals, randomizing 1150 acutely ill patients requiring hospital care between July 10, 2023, and October 31, 2023 one-to-one into two groups: intervention (HaH) and control (B&M). The primary analysis was an intention-to-treat non-inferiority analysis of the primary outcome, which was a composite of 30-day all-cause mortality and unplanned readmissions. Secondary outcomes included 30-day readmission, all-cause mortality, and patient experience.</p><p><strong>Results: </strong>The mean age was 67.8 (standard deviation [SD] 16.3) years, and 52.2% were female. The primary outcome occurred in 99 (17.3%) HaH patients and 114 (19.8%) B&M patients (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.63-1.14, p = .28), meeting the non-inferiority criterion. Thirty-day unplanned readmission occurred in 84 (14.7%) HaH patients and 101 (17.5%) B&M patients (OR 0.81, 95% CI 0.59-1.11, p = .19). Thirty-day all-cause mortality occurred in 25 (4.4%) HaH patients and 19 (3.3%) B&M patients (OR 1.34, 95% CI 0.73-2.46, p = .35). No HaH patients died while receiving their hospital care at home. HaH program was associated with a higher likelihood of patients reporting feeling extremely comfortable or very comfortable (84.4% HaH; 60.9% B&M, p = .001).</p><p><strong>Conclusion: </strong>A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hospital medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/jhm.70076","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hospital-at-home programs (HaH) in the United States have evolved to include a virtual-hybrid delivery model, where all physician encounters are virtual and partnered with a home care team.
Objective: To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick-and-mortar (B&M) hospital care.
Methods: We conducted a pragmatic trial at three hospitals, randomizing 1150 acutely ill patients requiring hospital care between July 10, 2023, and October 31, 2023 one-to-one into two groups: intervention (HaH) and control (B&M). The primary analysis was an intention-to-treat non-inferiority analysis of the primary outcome, which was a composite of 30-day all-cause mortality and unplanned readmissions. Secondary outcomes included 30-day readmission, all-cause mortality, and patient experience.
Results: The mean age was 67.8 (standard deviation [SD] 16.3) years, and 52.2% were female. The primary outcome occurred in 99 (17.3%) HaH patients and 114 (19.8%) B&M patients (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.63-1.14, p = .28), meeting the non-inferiority criterion. Thirty-day unplanned readmission occurred in 84 (14.7%) HaH patients and 101 (17.5%) B&M patients (OR 0.81, 95% CI 0.59-1.11, p = .19). Thirty-day all-cause mortality occurred in 25 (4.4%) HaH patients and 19 (3.3%) B&M patients (OR 1.34, 95% CI 0.73-2.46, p = .35). No HaH patients died while receiving their hospital care at home. HaH program was associated with a higher likelihood of patients reporting feeling extremely comfortable or very comfortable (84.4% HaH; 60.9% B&M, p = .001).
Conclusion: A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care.
背景：美国的居家医院项目（HaH）已经发展到包括虚拟-混合交付模式，在这种模式下，所有医生的接触都是虚拟的，并与家庭护理团队合作。目的：研究技术支持的虚拟混合HaH程序是否具有与传统实体（B&M）医院护理相似的临床结果。方法：我们在三家医院进行了一项实用试验，将1150名在2023年7月10日至2023年10月31日期间需要住院治疗的急性病人随机分为两组：干预组（HaH）和对照组（B&M）。主要分析是对主要结局进行意向治疗非劣效性分析，主要结局是30天全因死亡率和计划外再入院的综合结果。次要结局包括30天再入院、全因死亡率和患者经历。结果：患者平均年龄67.8岁（标准差[SD] 16.3），女性占52.2%。主要结局发生在99例（17.3%）HaH患者和114例（19.8%）B&M患者中（优势比[OR] 0.85, 95%可信区间[CI] 0.63-1.14, p = 0.28），符合非劣效性标准。有84例（14.7%）ha患者和101例（17.5%）B&M患者发生30天意外再入院（OR 0.81, 95% CI 0.59-1.11, p = 0.19）。25例ha患者（4.4%）和19例B&M患者（3.3%）发生30天全因死亡率（OR 1.34, 95% CI 0.73-2.46, p = 0.35）。没有病人在家中接受医院护理时死亡。HaH方案与患者报告感觉极度舒适或非常舒适的可能性较高相关(84.4% HaH；60.9% B&M, p = .001)。结论：混合型体外循环模式是传统B&M医院护理的一种安全、舒适的选择。
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
