Comprehensive geriatric hospital-at-home increases the days at home in older adults compared to bed-based intermediate care: a propensity score matching analysis

Objectives To compare the effectiveness and safety of Hospital-at-Home based on Comprehensive Geriatric Assessment (CGA-HaH) for older adults with bed-based Intermediate Care Unit (BBU). Design Cohort study comparing all consecutive CGA-HaH cases managed between January 2018 and December 2023 with contemporary BBU-matched controls at the largest geriatric care provider in Barcelona. Methods We linked all intermediate care admissions at Parc Sanitari Pere Virgili to the Catalan health information system data to track patients’ trajectories from 6 months before the index episode to June 2024. Patients admitted to CGA-HaH were matched to BBU controls using propensity score matching (PSM) based on their baseline characteristics. We used multivariable linear regression to assess the association of CGA-HaH with the percentage of days spent at home (%DSH) and Cox regression to assess the risk of death and first re-hospitalisation. Results We included 1180 consecutive CGA-HaH and 10,528 BBU episodes. CGA-HaH patients were significantly older and more functionally impaired and had better socioeconomic status. After PSM, we compared 961 CGA-HaH and 961 BBU patients, with a mean follow-up of 705 days (SD 593). CGA-HaH patients had a 7.4 higher %DSH (95% CI: 4.5–10.2, P < 0.001) with similar first re-hospitalisation [HR 1.02 (95% CI: 0.91–1.1)] and mortality risk [HR: 0.93 (95% CI: 0.81–1.06)]. Conclusions Our results suggest that CGA-Hospital-at-Home is a viable alternative to traditional inpatient intermediate care for older adults, offering relevant advantages such as increased time spent at home without a rise in mortality.