Study Evaluates Hospital-at-Home For Low Risk Medical Conditions Interview with:

Dr. Jared Conley

Dr. Jared Conley

Jared Conley, MD, PhD, MPH
Department of Emergency Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, MA 02114 What is the background for this study? What are the main findings?

Response: As the U.S. healthcare system seeks to improve the health of populations and individual patients, there is increasing interest to better align healthcare needs of patients with the most appropriate setting of care—particularly as it relates to hospital-based care (accounting for 1/3 of total U.S. healthcare costs).

Avoiding hospitalization—as long as safety and quality are not compromised—is often preferred by patients and the added benefit of potentially making care more affordable further promotes such care redesign efforts. There is a growing body of research studying alternative management strategies to hospitalization; we sought to comprehensively review and analyze this work. Alternative management strategies reviewed include outpatient management, quick diagnostic units, observation units, and hospital-at-home. What is the background for this study? What are the main findings?

Response: Findings from our review demonstrated that, after appropriate risk-stratification in an emergency department or clinic, several low-risk acute medical conditions could be safely managed without conventional hospitalization through the use of alternative care settings. For outpatient management, there was no significant difference in mortality, disease-specific outcomes, or patient satisfaction compared with inpatient admission for several conditions. For quick diagnostic units, the evidence was more limited, however mortality rates were very low and patient satisfaction was high. For hospital-at-home, a range of acute medical conditions had mortality rates, disease-specific outcomes, and patient/caregiver satisfaction that were either improved or no different compared with inpatient admission. For observation units, many conditions were found to have no difference in mortality, a decreased length of stay, and improved patient satisfaction compared to inpatient admission; results for some conditions were more limited without inpatient comparison. Across all alternative management strategies, there was heterogeneity amongst cost data but near-universal savings when evaluated. What should readers take away from your report?

Response: There is a growing body of evidence demonstrating the safety, and often increased desirability among patients, of managing low-risk acute care without conventional hospitalization through the use of alternative management strategies. Further study and application of this evidence is ripe with opportunity as the U.S. health care system seeks to improve the health of populations and individual patients at a more affordable and sustainable cost. What recommendations do you have for future research as a result of this study?

Response: For those acute medical conditions and alternative management strategies without sufficient level 1 evidence, further study is warranted as outlined in our review. There is also an opportunity for additional research to continually improve in our ability to determine which patients are best suitable for alternative management strategies to inpatient hospitalization. In addition, research is required to better determine appropriate U.S. payment models (e.g. bundled care payments) for some of these alternative management strategies, especially hospital-at-home programs. Thank you for your contribution to the community.

Alternative Strategies to Inpatient Hospitalization for Acute Medical Conditions
A Systematic Review

Jared Conley, MD, PhD, MPH1,2,3,4; Colin W. O’Brien, BS5; Bruce A. Leff, MD6; et al

JAMA Intern Med. Published online October 3, 2016. doi:10.1001/jamainternmed.2016.5974

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]




Last Updated on October 10, 2016 by Marie Benz MD FAAD