The investigation delves into Kaiser Permanente’s hospital-at-home program’s scalability and care quality compared to traditional inpatient care. Published in The American Journal of Managed Care, the study covers data from April 2020 to November 2021, analyzing admissions to Kaiser Permanente at Home versus inpatient care. Results show successful scalability with a rise from 7.2 to 12.7 patients daily and reduced length of stay. Although the hospital-at-home model presented lower delirium rates, the exact equivalence in quality outcomes wasn’t determined. Nonetheless, it suggests that the program could serve as an alternative to conventional hospital care for acute illnesses.
The introduction sets the stage for understanding Kaiser Permanente’s endeavor to scale its hospital-at-home program. Highlighting the surge in popularity post the CMS’s Acute Hospital Care at Home waiver, it details the collaboration between Kaiser Permanente and Medically Home Group in launching the program in April 2020. The aim of the study, published in The American Journal of Managed Care, was to assess the program’s scalability and care quality concerning inpatient care. It discusses the methodologies adopted and the contextual framework for evaluating the hospital-at-home model’s efficacy.
Recent research conducted by Kaiser Permanente unveils the successful expansion of its hospital-at-home program, contributing to enhanced hospital capacity. Yet, the study encountered challenges in assessing the program’s care quality during the scaling process.
Featured in The American Journal of Managed Care, the study aimed to evaluate the feasibility of enlarging a hospital-at-home initiative within an integrated healthcare delivery system.
Despite the hospital-at-home model’s existence for decades, it gained significant traction when the Centers for Medicare and Medicaid Services (CMS) introduced the Acute Hospital Care at Home waiver in November 2020. This waiver empowered hospitals to deliver inpatient-level care at patients’ homes for Medicare fee-for-service and non-managed care Medicaid beneficiaries. By December 14, 308 hospitals across 37 states had obtained approval for the waiver.
In collaboration with the Medically Home Group, Kaiser Permanente in the Portland, Oregon, metropolitan area initiated a hospital-at-home program in April 2020. Researchers conducted a retrospective cohort study of the Kaiser Permanente at Home program to ascertain its scalability.
Patients were admitted to the program through the emergency department and received treatment at home facilitated by technology and an in-home care team. Each morning, a team consisting of nurses, physicians, nurse practitioners, and a pharmacist convened for a huddle to devise the care plan. The attending physician conducted scheduled video visits akin to rounds in a traditional hospital. Patients were equipped with various technologies, including a tablet to connect with the care team, wireless-enabled vital sign equipment, and an emergency response device worn on the wrist.
The study analyzed data for patients requiring hospital-level care between April 29, 2020, and November 14, 2021, comparing care received through Kaiser Permanente at Home to traditional inpatient care.
The program underwent three stages of scaling during the study period: Stage 1 (April 29, 2020, to September 2020) maintained a daily census below ten patients; Stage 2 (October 2020 to February 2021) allowed a daily census cap of 15 patients; and Stage 3 (March 2021 onwards) raised the maximum daily census to 25 patients.
Throughout the study period, 1,005 patients received admission to the Kaiser Permanente at Home program. The average daily census rose from 7.2 in Stage 1 to 12.7 in Stage 3. The median length of stay for hospital-at-home patients decreased from 7.43 days in Stage 1 to 5.46 days in Stage 3, while readmission rates dropped from 11.52 percent in Stage 2 to 9.24 percent in Stage 3.
In a subgroup analysis comparing 59 Kaiser Permanente at Home patients to 1,738 admitted to traditional inpatient care, researchers found a similar risk of 30-day readmission for both groups. Moreover, Kaiser Permanente at Home patients were marginally less prone to experiencing delirium than those in the traditional hospital setting. However, hospital-at-home patients had a 1.41-day longer length of stay than traditional inpatient setting patients.
Nevertheless, the researchers cautioned that “the imprecise comparisons in the small subgroup are insufficient to establish equivalence for quality outcomes.”
Nevertheless, the researchers concluded that “Kaiser Permanente at Home can be implemented at scale for acute medical illness requiring hospital-level care as an alternative to traditional hospital care.”
This study contributes to the growing body of research on the hospital-at-home care model.
In November, CMS released findings from an analysis covering the initial 16 months of the Acute Hospital Care at Home initiative. Researchers assessed patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023, involving 11,159 patients who received care under the waiver during the study period.
The study revealed that the overall proportion of patients transferred from home to the hospital was 7.20 percent. Among participating hospitals, there were 38 unexpected deaths (0.34 percent), mostly occurring in COVID-19 patients who progressed to severe illness.
Overall, the study’s key findings and implications. It highlights successful scalability, evident from increased daily census and reduced lengths of stay within Kaiser Permanente’s hospital-at-home program. While noting lower delirium rates and comparable 30-day readmission risks, it cautions against drawing definitive equivalence in quality outcomes compared to traditional inpatient care. Nevertheless, the study suggests that the hospital-at-home model holds promise as an alternative for acute illnesses, emphasizing the need for further research and refinement to ensure optimal care delivery.
