Virtual Home Care for Patients With Acute Illness
Josh Banerjee, Christopher J. Lynch, Hugh Gordon, C. Edward Coffey, Catherine P. Canamar, Soodtida Tangpraphaphorn, Karla González, Neha Mahajan, Jan Shoenberger, Michael Menchine, Andrew Oh, Emily L. Johnson, Molly Grassini, Rachel Baden, Paul Holtom, Douglass Hutcheon, Brandon M. Wiley, Kusha Davar, Sheila Mallet-Smith, Margaret Sanfratello, B E Villacís Gallardo, Meixine Song, Nikole Swain, Mario Solís, J Lapa e Silva, Charmaine Pablico, Eduardo Aceves, Erica Bonilla, Ria Ashley Legaspi, David Ladrón de Guevara H., K Y Lee, Christina Martinez, Michelle Banh, Dana Russell, Lissette Cervantes, Jacqueline Cervantes, Cesar Gonzalez, Phillip Sheth, Shadi Dowlatshahi, Alex Rosenberg, P Patel, Wei-An Lee, Tanzim Khan, Tze‐Woei Tan, Michael Fong, Samuel S. Gordon, Brandi Clark, Víctor Hugo Peña, Steven Dohi, Beatrisa Bannister, Roman Villalta, Priya Induru, Pauline Vuong, David Lwe, Karen Stoffel, Sam S. Oh, Christian Voyageur, Andrew Cool, Yong‐Jae Lee, Stephen Lenh, Janet Luong, Gary Hanna, Jason N. Doctor, Bryan Munoz, C. Castro, Edgar Solis, Nancy Blake, Roza Sakzalyan, Christopher J. Rodriguez, C. Ghaly, Jorge Orozco, Hal F. Yee, Brad Spellberg
Abstract
Importance: Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization. Objective: To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home. Design, Setting, and Participants: This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized. Exposure: Outpatient, home-based, acute care with virtual monitoring and clinic visits in lieu of inpatient or in-home care. Main Outcomes and Measures: The primary measure was hospital length of stay. Secondary measures included all-cause mortality, 30-day readmission, return urgent care visit rates, and return emergency department (ED) visit rates. Results: Safer@Home provided care to 876 patients (mean [SD] age, 54.0 [14.5] years; 541 men [61.8%]) during the study period, compared with a cohort of 1590 patients (mean [SD] age, 52.3 [19.6] years; 901 men [56.7%]) with matching diagnoses who received standard, hospital-based care. Safer@Home patients had significantly shorter mean (SD) lengths of inpatient stay than the comparison cohort (1.3 [2.0] vs 5.3 [10.4] days; P < .001), totaling 3505 bed-days avoided (mean [SD], 4.0 [10.6] bed-days saved per patient), with no significant difference in all-cause mortality at last follow-up (2.6% [23 of 876] vs 4.0% [64 of 1590]; P = .07). Safer@Home patients and control patients also had no significant difference in the proportion experiencing 30-day hospital readmission (19.9% [174 of 876] vs 16.7% [266 of 1590]; P = .06). As intended, more Safer@Home than control patients had at least one 30-day return urgent care visit (37.3% [327 of 876] vs 5.2% [82 of 1590]; P < .001). In contrast, the Safer@Home and control cohorts did not significantly differ in experiencing at least one 30-day return ED visit (15.2% [133 of 876] vs 12.5% [199 of 1590]; P = .06). Safer@Home patients had significantly fewer mean (SD) total 30-day return ED visits per patient than control patients (0.19 [0.50] vs 0.21 [0.85]; P < .001). Conclusions and Relevance: In this cohort study, patients receiving acute, virtual, home care with remote monitoring and as-needed return urgent care visits had markedly shorter hospital stays than patients receiving standard inpatient hospital care, with no significant increase in mortality, ED revisits, or return hospitalizations. This new care model is promising for systems that cannot staff Medicare-compliant hospital-at-home visits.