The pilot study recruited a total of 20 patients admitted to the ED at BWH or BWFH. Eligible participants included patients with any infection, such as pneumonia or cellulitis, or increase of heart failure, chronic obstructive pulmonary disease or asthma. Nine patients were randomized to receive care at home while 11 received usual care within the hospital setting. Dr. David Levine, who is a physician and researcher in the Division of General Internal Medicine and Primary Care at BWH, is the lead author of the study that was recently published in The Journal of General Internal Medicine.
Participants in the study needed to live nearby to qualify. That’s where BWFH’s patient population was ideal. “As a community hospital, we serve the surrounding neighborhoods,” says Dr. Paul Chen, Associate Chief of Emergency Medicine at BWFH. “That’s helpful to the visiting medical team as they can only travel so far.”
Dr. Chen says approaching potential participants for the study posed an interesting challenge. “Most people come to the hospital thinking that they will have to stay in the hospital if they have something this serious,” he explains. “There are some patients who right away think being admitted to home is a great idea, but there are others for whom it’s not what they are expecting and they are unsure.”
However, as an emergency medicine provider, Dr. Chen says there are many benefits to home hospital care for both the patient and the hospital. “It’s not like an old-fashioned house call. There is modern technology involved,” he says. “We’re able to get them home and give them the treatment they would have otherwise gotten in the hospital, but they get to be home with their families and sleep in their own bed.”
Patients in the pilot study who were admitted to home received a daily visit from an attending general internist and two daily visits from a registered home health nurse. They also benefited from 24-hour physician coverage and cutting-edge connectivity, including continuous monitoring, video and texting.
Dr. Chen says not being admitted to the hospital reduces the risk of a hospital-acquired infection as well as the risk of medical error. Plus, at home, the attending physician can review the patient’s medication list more thoroughly and assess the environment for safety.
“For those that are eligible, it’s a great program,” says Dr. Chen. “And it has secondary benefits as well, because it allows us to save inpatient beds for patients who aren’t eligible for the program or are too sick to be cared for at home.”
To learn more about the program, watch this CBS News report.