Differences in Clinical Care: Considerations in Hospital at Home

Background International studies indicate that Hospital at Home (HaH) yields positive clinical outcomes, including reduced readmissions, lower hospital-acquired debility, and patient-centered experience. Studies have generally compared HaH to traditional, brick-and-mortar (BAM) hospital care, though there is little peer-reviewed literature about the appropriate and necessary changes to clinical care that must be considered when initiating and scaling HaH. Methods Using a case-based approach, we will explore how adjusting the timing of treatments, employing point-of-care testing, emphasizing patient-centric care, adopting new practices for glycemic management, and considering optimal venous thromboembolism (VTE) prophylaxis can improve the patient experience while promoting efficient use of geographically distributed resources without diminishing the acuity of patient care delivered. While these cases reflect the experience of Hospital at Home in the United States, these cases and concepts are generalizable across international programs. Discussion These cases outline the ways that HaH programs adjust clinical care to accommodate the complex logistics of coordinating care in the home across broad geographies given finite capacity of in-home services. Additionally, these cases provide clear examples of how person-centered care is accomplished in HaH, often by deviating from practices that are routine in the BAM hospital. Conclusions As HaH adoption expands, continued research is needed to establish standards in these areas that ensure patient safety, quality of care, equitable access, and enhanced care experience.