Association of Costs and Days at Home With Transfer Hospital in Home

Abstract

MAIN OUTCOMES AND MEASURESThe main outcomes were hospital length of stay, 30-day and 90-day readmissions, VA direct costs, combined VA and Medicare costs, mortality, 90-day nursing home use, and days at home after hospital discharge. An intent-to-treat analysis of cost and utilization was performed. RESULTSA total of 405 veterans (mean [SD] age, 66.7 [0.83] years; 399 men [98.5%]) with medically complex conditions, primarily congestive heart failure and chronic obstructive pulmonary disease exacerbations (mean [SD] hierarchical condition categories score, 3.54 [0.16]), were enrolled. Ten participants could not be matched, so analyses were performed for 395 veterans (all of whom were men), 98 in the T-HIH group and 297 in the control group. For patients in the T-HIH group compared with the control group, length of stay was 20% lower (6.

Remote vs In-home Physician Visits for Hospital-Level Care at Home

“…The concept of decentralizing hospital care to the home contrasts with most theories on economies of scale, yet outcomes on cost and quality make the intervention high value. [16][17][18] One criticism of home hospital care is the inefficiency incurred by the attending physician or advanced practice clinician. Patient-physician ratios are typically lower for home hospital care than traditional medical wards, in part because of the need to travel to each patient.…”

“…The concept of decentralizing hospital care to the home contrasts with most theories on economies of scale, yet outcomes on cost and quality make the intervention high value . One criticism of home hospital care is the inefficiency incurred by the attending physician or advanced practice clinician.…”

Age‐Friendly Health Systems: Improving care for older adults in the Veterans Health Administration

“…12 The number of Veterans aged 85 and older is anticipated to increase by 38% between 2019 and 2039 thus necessitating the involvement of the Veterans Health Administration (VHA) in initiatives such as AFHS to better meet the needs of our oldest Veterans. 13 The VHA set the aim to become the largest age-friendly health system in the U.S. As of November older Veterans across the system with 4Ms care in diverse settings, including inpatient units, outpatient primary care, surgical and specialty care clinics, Home Based Primary Care (HBPC), hospital at home, 14,15 spinal cord injury units, emergency departments (ED), the Caring for Older…”

“…The VHA set the aim to become the largest age‐friendly health system in the U.S. As of November 1, 2022, 152 care settings across 78 VA Medical Centers (VAMCs) have been recognized by IHI with more than a third of those teams earning Level 2 recognition. VHA is reaching older Veterans across the system with 4Ms care in diverse settings, including inpatient units, outpatient primary care, surgical and specialty care clinics, Home Based Primary Care (HBPC), hospital at home, 14,15 spinal cord injury units, emergency departments (ED), the Caring for Older Adults and Caregivers at Home (COACH) dementia support program, Geriatric Resources for Assessment and Care of Elders (GRACE) care management, 16 and Community Living Centers (CLCs, analogous to nursing homes). This commentary highlights how VHA is working toward system‐wide spread and offers key insights in this special journal issue.…”

“…12 The number of Veterans aged 85 and older is anticipated to increase by 38% between 2019 and 2039 thus necessitating the involvement of the Veterans Health Administration (VHA) in initiatives such as AFHS to better meet the needs of our oldest Veterans. 13 The VHA set the aim to become the largest age-friendly health system in the U.S. As of November specialty care clinics, Home Based Primary Care (HBPC), hospital at home, 14,15 spinal cord injury units, emergency departments (ED), the Caring for Older Adults and Caregivers at Home (COACH) dementia support program, Geriatric Resources for Assessment and Care of Elders (GRACE) care management, 16 and Community Living Centers (CLCs, analogous to nursing homes). This commentary highlights how VHA is working toward system-wide spread and offers key insights in this special journal issue.…”