Table 1 Core Programmatic Elements of HaH from Studies Treating Multiple Diagnoses
Trial | Core Programmatic Elements of HaH | Summary of Outcomes | |||||||
|---|---|---|---|---|---|---|---|---|---|
Targeting patient requiring hospitalization | Delivering hospital-level services at home | Daily RN visits | Clinician (MD, NP) home visits | 24/7 availability to patients and family members | Length of Stay | Mortality | Satisfaction | Total Acute Cost | |
Stressman et al. (1996) [7] | ✔ | ✔ | ✔a | ✔ | ✔ | aAverage utilization fell 9.4% in HH group; rose 2.3% in geriatric control group | no comparison | 96% report physician and nursing care was “very good” or “good” | “Total savings estimated to be $5.62 million” |
Wilson et al. (1999) [8] | ✔ | ✔ | ✔ | ✔ | ✔ | 8 days vs. 14.5 days for controls (median, p = 0.026) | 25% vs. 31% for controls at 3 months (RR 0.82, 95% CI 0.52 to 1.28) | Total satisfaction on 6-item questionnaire: 15 for HaH vs. 12 for controls (p = .001) | £2594 vs. £3659 for controls (p = .011) |
Caplan et al. (1999) [9] | ✔ | ✔ | ✔ | ✔ | ✔ | 10.1 days vs. 7.4 days for controls (p > .05) | No significant difference between groups at 28 days | Caregiver satisfaction significantly higher amongst HaH group vs. hospital controls (difference − 0.8 on a 4-point scale, P < 0.0001), with 55 and 27% response rate, respectively. | $1764 vs. $3775 for controls |
Harris et al. (2005) [10] | ✔ | ✔ | ✔ | ✔ | ✔ | 8.8 days vs. 5.7 days days for controls (p < 0.0001) | Not reported | HaH patients rating satisfaction as ‘very good’ or ‘excellent’ vs. those in the hospital group - 83.0% versus 72.3%, p = .05. Relatives of HaH rating satisfaction as ‘very good’ or ‘excellent’ vs. those of controls - 66.7% versus 41.3%, p = .004 | NZ$6524 vs. NZ$3525 for controlsa |
Leff et al. (2005) [5] | ✔ | ✔ | ✔ | ✔ | ✔ | 3.2 days vs. 4.9 days for controls (p = .004) | 0% vs. 3% for controls (p = .05) | Satisfaction of patients (median, 7 vs. 6 domains; p < 0.001) and family members (median, 6 vs. 5 domains; p < 0.001) was greater in the intervention group and remained statistically significant when controlled for covariates | $5081 vs. $7480 for controls (p < 0.001) |
Cryer et al. (2012) [11] | ✔ | ✔ | ✔ | ✔ | ✔ | 3.3 days vs. 4.5 days for controls | 0.93% vs. 3.4% for controls | HCAHPS overall patient satisfaction mean score for HaH group of 90.7 exceeded the hospital score of 83.9 for comparable patients. | “19% lower” |
Summerfelt et al. (2015) [12] | ✔ | ✔ | ✔ | ✔ | ✔ | 3.64 days vs. 4.31 days for controls (p = .088) | 2% vs 2% for controls (p = 0.86) | HaH patients reported higher overall satisfaction score (4.40 vs 4–.01; P = .001) | N/A |