Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?
Authors: David M. Levine, Michael Montalto, Bruce Leff
Journal: Annals of Internal Medicine (2021)

LettersNovember 2021Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?David M. Levine, MD, MPH, MA, Michael Montalto, PhD, Bruce Leff, MDDavid M. Levine, MD, MPH, MABrigham and Women Hospital and Harvard Medical School, Boston, Massachusetts, Michael Montalto, PhDHospital in the Home and Epworth Hospital, East Melbourne, Victoria, Australia, Bruce Leff, MDJohns Hopkins University School of Medicine, Baltimore, MarylandAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0614 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We read with interest Shepperd and colleagues' (1) study of hospital at home (HAH) for admission avoidance. We congratulate the authors for a multisite deployment of a complex care model. The trial unfortunately failed to show superiority for its primary outcome (that is, living at home at 6 months) and several secondary outcomes. Here, we highlight 3 issues that may explain their null findings.First, there is some variation in the definition of HAH care. However, it is generally defined as the provision of hospital-level care in a patient's home as a substitute for care that would ...References1. Shepperd S, Butler C, Cradduck-Bamford A, et al. Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons? A randomized trial. Ann Intern Med. 2021;174:889-98. [PMID: 33872045] doi:10.7326/M20-5688 LinkGoogle Scholar2. Leff B, Montalto M. Home hospital-toward a tighter definition [Letter]. J Am Geriatr Soc. 2004;52:2141. [PMID: 15571559] CrossrefMedlineGoogle Scholar3. Levine DM, Ouchi K, Blanchfield B, et al. Hospital-level care at home for acutely ill adults. A randomized controlled trial. Ann Intern Med. 2020;172:77-85. [PMID: 31842232] doi:10.7326/M19-0600 LinkGoogle Scholar4. Federman AD, Soones T, DeCherrie LV, et al. Association of a bundled hospital-at-home and 30-day postacute transitional care program with clinical outcomes and patient experiences. JAMA Intern Med. 2018;178:1033-40. [PMID: 29946693] doi:10.1001/jamainternmed.2018.2562 CrossrefMedlineGoogle Scholar5. Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143:798-808. [PMID: 16330791] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women Hospital and Harvard Medical School, Boston, MassachusettsHospital in the Home and Epworth Hospital, East Melbourne, Victoria, AustraliaJohns Hopkins University School of Medicine, Baltimore, MarylandNote: Dr. Levine receives principal investigator–initiated grant funding from Biofourmis and IBM. Dr. Leff serves as a clinical advisor to Medically Home, Dispatch Health, and the Chartis Group. These arrangements have been reviewed and approved by the Johns Hopkins University in accordance with its conflicts of interest policy.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0614. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIs Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? Sasha Shepperd , Chris Butler , Andrea Cradduck-Bamford , Graham Ellis , Alastair Gray , Anthony Hemsley , Pradeep Khanna , Peter Langhorne , Sam Mort , Scott Ramsay , Rebekah Schiff , David J. Stott , Angela Wilkinson , Ly-Mee Yu , and John Young Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? Sasha Shepperd , Graham Ellis , Rebekah Schiff , David J. Stott , and John Young Metrics Cited byA research agenda for hospital at home November 2021Volume 174, Issue 11Page: 1633 ePublished: 16 November 2021 Issue Published: November 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...