Safety and Cost-Effectiveness of Hospital at Home in Patients with COVID-19

Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly affected the capacity of health systems across the United States. Although not widely used before the pandemic, the hospital-at-home (HaH) model emerged as a potential strategy to alleviate hospital burden by providing hospital-level care in the home setting. This study aims to evaluate the safety, clinical effectiveness, and cost-efficiency of a HaH program for patients with COVID-19, comparing these outcomes with those of traditional in-hospital care. Methods: A retrospective matched case-control study was conducted at a major academic medical center in the southeastern United States. The study included 200 patients with confirmed COVID-19, 100 of whom were enrolled in the HaH program between February 1, 2021 and January 31, 2022, and 100 served as matched controls who received conventional hospital care. Matching criteria included age, sex, and admission to the intensive care unit. The primary outcomes assessed were 30-day readmission rates and inpatient length of stay (iLOS). Secondary outcomes included total length of stay (tLOS), emergency department visits within 30 days, and detailed cost analysis, including fixed and variable costs. Results: The analysis included 200 patients (mean age 50.4 years, standard deviation 14.2; 55% female). There were no significant differences between the HaH and control groups in terms of age, sex, or intensive care unit admission rates. The study found no statistically significant differences in 30-day readmissions (11% vs 14%, P = 0.48), days to readmission (9.0 vs 11.8, P = 0.32), or 30-day emergency department visits (18% vs 20%, P = 0.72) between the HaH and control groups. The HaH group had a significantly shorter iLOS (5.7 vs 9.4 days, P = 0.04), however, although tLOS was longer (13.0 vs 9.4 days, P < 0.001). The HaH program also demonstrated cost benefits, with significantly lower inpatient fixed costs ($675,668 vs $1,469,098, P = 0.02) and total inpatient costs ($1,268,944 vs $2,995,512, P = 0.01). Conclusions: The HaH program for COVID-19 patients offered a safe alternative to traditional hospitalization, with similar clinical outcomes and significant reductions in inpatient costs. The shorter iLOS suggests potential benefits in hospital resource management during surge periods, while the longer tLOS highlights the need for optimized patient selection and care strategies in the home setting. Further research is warranted to explore the long-term economic implications and patient outcomes of HaH programs, particularly during heightened demand, on healthcare systems.