Hospital-Level Care at Home for Adults Living in Rural Settings

For patients living in rural areas, how do cost, 30-day readmission rates, physical activity levels, and patient experience differ between those receiving acute care at home (home hospital) and those receiving care in a traditional brick-and-mortar hospital?In this 3-site randomized clinical trial of 161 adult patients living in rural areas, there were no significant adjusted mean differences in cost or 30-day readmission rates, but patients who received home hospital were more physically active and strongly preferred it over brick-and-mortar hospital care. As implemented, patients were transferred home late in their course (mean day of transfer, 4.2 of 6.7 days), likely attenuating the effect of the intervention on cost and readmission.These findings suggest that home hospital care in rural settings is a feasible care model for acutely ill adults.

Corresponding Author: David M. Levine, MD, MPH, MA, Harvard Medical School, Ariadne Labs, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont St, 3rd Floor, Boston, MA 02120 (dmlevine@bwh.harvard.edu).

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