Choosing Inpatient vs Home Treatment: Why Patients Accept or Decline Hospital at Home

Abstract

BACKGROUND/OBJECTIVESHospital at home (HaH) provides interdisciplinary acute care in the home as a substitute for inpatient hospitalization. Studies have demonstrated that HaH care is associated with better quality care, fewer complications, and better patient and caregiver experience. Still, some patients decline HaH. The objective of the study was to characterize patients who accept vs decline HaH care and describe reasons for their decisions in the context of a Center for Medicare and Medicaid Innovation demonstration of HaH.DESIGN/SETTING/PARTICIPANTSA total of 442 patients with Medicare or other eligible insurance, 18 years or older, who met study eligibility criteria were offered HaH at Mount Sinai Hospitals in New York, NY, between September 1, 2014, and August 31, 2017.MEASUREMENTSReasons for accepting or declining HaH were recorded. Age, sex, insurance type, and admission diagnoses of HaH acceptors and refusers were compared in univariate analyses.RESULTSOf the 442 patients offered HaH, 66.7% accepted. Main reasons for enrolling in HaH included being more comfortable at home (78.2%) and being near family (40.7%). Specific reasons given for refusing HaH included preferring in‐hospital care (15.0%) and concern that HaH would not meet care needs (12.9%).CONCLUSIONTwo‐thirds of patients offered HaH care opted to receive it. The reasons for declining HaH provided by those who chose not to participate should be considered for quality improvement, and reasons for acceptance may be helpful in marketing and other efforts to promote HaH participation. J Am Geriatr Soc 68:1579‐1583, 2020.

Rural Perceptions of Acute Care at Home: A Qualitative Analysis

“…Second, perception may be different from acceptance in the face of acute illness. However, similar issues identified here have also been identified in urban home hospital 27 . Third, interviewing patients who already receive some of their medical care from a large academic center may have introduced bias toward preferring care from that center rather than from their local hospital system.…”

“…Unknowns remained surrounding reimbursement and the fallout of potentially competing with an existing rural hospital. Many issues we found, including low health literacy, challenging travel times, and lack of caregiver support matched those raised in the urban setting 27 . Most saw rural home hospital as complementary to traditional hospitals, while others viewed the 2 potentially at odds.…”

Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study

“…At a broad level, contextual factors for consideration include hospital location and resources and healthcare payment structures. Given the targeted approach of these programmes, HaH may be more practical for larger hospitals with sufficient and predictable casemix to allow for greater economies of scale (27)(28)(29).…”

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis

“…In a similar population Georgiadis and Corrigan [ 9 ] highlighted the need for families and caregivers to be involved in an older adults discharge plan, with negative experiences of discharge planning linked to a lack of communication and engagement with their healthcare teams. Exploring the impact of ESD interventions on the patient and their caregiver would allow for ESD services to be tailored to include the patient and their caregiver in a shared decision-making process with consent from the older person [ 36 ].…”