The Hospital at Home Model: Bringing Hospital-Level Care to the Patient

Case Study
Key Questions Answered
  • What are the benefits and challenges of providing hospital-level care in the home?
  • What are the results of this kind of program?
Key Themes and Takeaways

This resource is a case study of the Hospital at Home program at Presbyterian Healthcare Services in Albuquerque, New Mexico, which offers patients who require hospitalization for conditions with well-defined treatment protocols the option of receiving care at home.

  • Teams of physicians, nurses, and other clinical staff make house calls to administer medications, arrange for lab tests, and provide education to patients with congestive heart failure, chronic obstructive pulmonary disease, and other conditions that can be safely treated at home. Patients must live in metropolitan Albuquerque and be covered by the system’s health plans.
  • Physicians visit once daily and may spend up to an hour with patients. Nurses and home health aides also spend significant time with patients. When needed, Presbyterian also sends social workers and rehabilitation specialists.
  • Patients benefit from being in a familiar environment, and providers gain an understanding of the challenges patients face at home, related to anything from following treatment recommendations to maintaining a healthy diet.
  • Presbyterian’s commercial and Medicare Advantage health plans pay a bundled rate for each program admission.
  • Excluding physician fees, the average cost of caring for patients was 19 percent lower than in the hospital, with shorter lengths of stay, fewer readmissions, lower mortality rates, and reduced falls.
  • Challenges include lack of reimbursement from the fee-for-service Medicare and Medicaid programs, establishing a patient census sufficient to cover the staffing and infrastructure needed, and finding staff who are comfortable functioning with greater independence.
Authors
Sarah Klein
Douglas McCarthy
Martha Hostetter
Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
Level of Evidence
Case Study; Promising Evidence
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