Researchers: Noa Zychlinski¹, Galia Barkai², Gad Segal², Eyal Zimlichman², Yair Goldberg¹

Background: Hospital-at-home (HAH) is emerging as a viable alternative to in-hospital care in specific clinical scenarios. However, its efficacy for acutely ill patients, typically treated in general-internal medicine departments, remains under investigation.

Objectives: First, compare the clinical outcomes of acutely ill patients admitted to either in-hospital or HAH settings. Second, study the dynamics of hybrid hospitals while addressing two operational questions: (i) how to direct patient admission and call-in policies based on individual characteristics and proximity and (ii) how to determine the optimal allocation of medical resources between these two hospitalization options.

Method: The study was conducted at a telemedicine-controlled HAH department within a tertiary medical center. It involved HAH patients (COVID-19 and non-COVID) matched with in-hospital patients. Key outcomes were compared. Moreover, we developed a model that capture the patient’s health evolution during remote/on-site hospitalization and optimized call-in policies under finite capacity and different patient types.

Findings: The median LOS was 2 days shorter for both COVID-19 and non-COVID patients in the HAH group compared to in-hospital patients. Readmission rates within 30 days were not significantly different between the groups. However, the 30-day mortality risk was significantly lower for patients in the HAH group.We also found that remote hospitalization may be cost-effective only for moderately distant patients.

Conclusions: Telemedicine-based HAH for acutely ill patients can reduce the length of hospitalization without increasing readmission risk and lower both 30-day and one-year mortality rates with a significant reduction in 30-day mortality.

Recommendations: Telemedicine-based HAH can be an effective alternative to traditional in-hospital care for acutely ill patients, potentially leading to shorter hospital stays and improved survival rates. Healthcare policies should consider integrating telemedicine HAH programs more broadly, especially for acute illnesses. Our insights on cost-effectiveness and proximity can guide policymakers in shaping future healthcare delivery and design.

Research end date: 08/2024