Virtual Home Care for Patients With Acute Illness
Authors: Banerjee Josh , Lynch Christopher , Gordon Hugh , Coffey Charles E. , Canamar Catherine P. , Tangpraphaphorn Soodtida , Gonzalez Karla , Mahajan Neha , Shoenberger Jan , Menchine Michael , Oh Andrew , Johnson Emily , Grassini Molly , Baden Rachel , Holtom Paul , Hutcheon Douglass , Wiley Brandon M. , Davar Kusha , Mallet-Smith Sheila , Sanfratello Margaret , Gallardo Brenda , Song Meixine , Swain Nikole , Solis Maria Lydia , Silva Jenny , Pablico Charmaine , Aceves Eduardo , Bonilla Erica , Legaspi Ria Ashley , Guevara Deisy M. , Lee Karissa , Martinez Christina , Banh Michelle , Russell Dana , Cervantes Lissette , Cervantes Jacqueline , Gonzalez Cesar , Sheth Phillip , Dowlatshahi Shadi , Rosenberg Alex , Patel Pruthul , Lee Wei-An , Khan Tanzim , Tan Tze-Woei , Fong Michael , Gordon Samuel S. , Clark Brandi , Pena Victor , Dohi Steven , Bannister Beatrisa , Villalta Roman , Induru Priya , Vuong Pauline , Lwe David , Stoffel Karen , Oh Sam , Voyageur Christian , Cool Andrew , Lee Yong , Lenh Stephen , Luong Janet , Hanna Gary , Doctor Jason N. , Munoz Bryan , Castro Concepcion , Solis Edgar , Blake Nancy , Sakzalyan Roza , Rodriguez Christopher J. , Ghaly Christina , Orozco Jorge , Yee Hal F. , Spellberg Brad 
Published: November 2024

Importance

Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization.

Objective

To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home.

Design, Setting, and Participants

This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized.

Exposure

Outpatient, home-based, acute care with virtual monitoring and clinic visits in lieu of inpatient or in-home care.

Main Outcomes and Measures

The primary measure was hospital length of stay. Secondary measures included all-cause mortality, 30-day readmission, return urgent care visit rates, and return emergency department (ED) visit rates.

Results

Safer@Home provided care to 876 patients (mean [SD] age, 54.0 [14.5] years; 541 men [61.8%]) during the study period, compared with a cohort of 1590 patients (mean [SD] age, 52.3 [19.6] years; 901 men [56.7%]) with matching diagnoses who received standard, hospital-based care. Safer@Home patients had significantly shorter mean (SD) lengths of inpatient stay than the comparison cohort (1.3 [2.0] vs 5.3 [10.4] days; P &amp;lt; .001), totaling 3505 bed-days avoided (mean [SD], 4.0 [10.6] bed-days saved per patient), with no significant difference in all-cause mortality at last follow-up (2.6% [23 of 876] vs 4.0% [64 of 1590]; P = .07). Safer@Home patients and control patients also had no significant difference in the proportion experiencing 30-day hospital readmission (19.9% [174 of 876] vs 16.7% [266 of 1590]; P = .06). As intended, more Safer@Home than control patients had at least one 30-day return urgent care visit (37.3% [327 of 876] vs 5.2% [82 of 1590]; P &amp;lt; .001). In contrast, the Safer@Home and control cohorts did not significantly differ in experiencing at least one 30-day return ED visit (15.2% [133 of 876] vs 12.5% [199 of 1590]; P = .06). Safer@Home patients had significantly fewer mean (SD) total 30-day return ED visits per patient than control patients (0.19 [0.50] vs 0.21 [0.85]; P &amp;lt; .001).

Conclusions and Relevance

In this cohort study, patients receiving acute, virtual, home care with remote monitoring and as-needed return urgent care visits had markedly shorter hospital stays than patients receiving standard inpatient hospital care, with no significant increase in mortality, ED revisits, or return hospitalizations. This new care model is promising for systems that cannot staff Medicare-compliant hospital-at-home visits.