Hospital-Level Care at Home for Adults Living in Rural Settings: A Randomized Clinical Trial

1. In this randomized clinical trial, home hospital care was both feasible and safe for rural patients needing hospital-level care. 

Evidence Rating Level: 1 (Excellent) 

Almost 20% of Canadians live in remote areas where it is difficult to access their nearest hospital. Furthermore, it is predicted that this lack of access will intensify as more rural hospitals are closing, and those receiving care there may encounter a potentially unsafe environment. Home hospital provides services traditionally offered in brick-and-mortar (BAM) hospitals. Previous studies have demonstrated that home hospital care enhances patient experiences while reducing mortality, costs, and readmissions. However, most programs have been done in urban areas with easier access to resources. To address gaps in rural settings, this study aims to evaluate whether rural home hospital (RHH) can deliver comparable outcomes to usual inpatient care. Eligible participants were randomized to either the RHH group vs the BAM group. In both groups, study staff administered surveys at admission, discharge and again 30 days post-discharge. A total of 165 individuals were enrolled (mean [SD] age 64.4 [17.2] years), with 82 randomized to the home group and 83 to the control group. Individuals in the home hospital group spent significantly less time being sedentary compared to those in the hospital care group (mean [SD], 78.0% [10.4%] vs 86.0% [7.2%]; mean difference, -8.0%, 95% CI, -12.8% to -3.3%; P<.001), and took more daily steps on average (mean [SD] 834.1 [1219.6] vs 120.4 [206.0]; mean difference 713.7 steps; 95% CI, 290.2 to 1137.2; P<.001). Between the RHH and control groups, the total mean [SD] length of stay did not significantly differ (6.7 [5.0] days for home hospital vs 5.4 [4.4] days for controls). Notably, patients in the home hospital group were transferred home relatively late in their acute care episode (mean [SD] day of transfer, 4.2 [4.3] of 6.7 days). Home hospital patients reported more positive experiences than those in the BAM group (mean [SD] Picker experience score 13.4 [2.6] vs 11.0 [3.0]; 95% CI, 1.0-3.8; P<.001). Overall, patient activity and experience improved with home care, while costs and readmission were unchanged. 

Click here to read this study in JAMA Network Open

Image: PD

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