Acute Hospital Care at Home in the United States: The Early National Experience
Authors: David M. Levine, Jeffrey Souza, Jeffrey L. Schnipper, Thomas C. Tsai, Bruce Leff, Bruce E. Landon
Journal: Annals of Internal Medicine (2024)

Letters9 January 2024Acute Hospital Care at Home in the United States: The Early National ExperienceDavid M. Levine, MD, MPH, MA, Jeffrey Souza, MA, Jeffrey L. Schnipper, MD, MPH, Thomas C. Tsai, MD, MPH, Bruce Leff, MD, Bruce E. Landon, MD, MBA, MScDavid M. Levine, MD, MPH, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MassachusettsSearch for more papers by this author, Jeffrey Souza, MADepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsSearch for more papers by this author, Jeffrey L. Schnipper, MD, MPHDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MassachusettsSearch for more papers by this author, Thomas C. Tsai, MD, MPHHarvard Medical School; Department of Surgery, Brigham and Women’s Hospital; and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MassachusettsSearch for more papers by this author, Bruce Leff, MDDivision of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MarylandSearch for more papers by this author, Bruce E. Landon, MD, MBA, MScDepartment of Health Care Policy, Harvard Medical School, and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-2264 Annals Author Insight Video - David M. Levine, MD, MPH, MA In this video, David M. Levine, MD, MPH, MA, offers additional insight into the article, "Acute Hospital Care at Home in the United States: The Early National Experience." (Duration 3:10) SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Hospitalization is the standard of care for acute illness, but hospital care is often expensive, unsafe, and uncomfortable (1). Acute hospital care at home (AHCaH) provides hospital-level care in patients’ homes as a substitute for brick-and-mortar care. Prior research has shown that compared with traditional inpatient hospital care, patients cared for in AHCaH have improved experiences and physical activity levels, with lower rates of mortality, readmission, and discharge to skilled-nursing facilities (2, 3). However, there are few data describing the experience of AHCaH at the national level. In November 2020, the Centers for Medicare & Medicaid Services issued the ...References1. Bates DW, Levine DM, Salmasian H, et al. The safety of inpatient health care. N Engl J Med. 2023;388:142-153. [PMID: 36630622] doi:10.1056/NEJMsa2206117 CrossrefMedlineGoogle Scholar2. 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 Scholar3. Arsenault-Lapierre G, Henein M, Gaid D, et al. Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta-analysis. JAMA Netw Open. 2021;4:e2111568. [PMID: 34100939] doi:10.1001/jamanetworkopen.2021.11568 CrossrefMedlineGoogle Scholar4. Levine DM, DeCherrie LV, Siu AL, et al. Early uptake of the acute hospital care at home waiver. Ann Intern Med. 2021;174:1772-1774. [PMID: 34698511] doi:10.7326/M21-2516 LinkGoogle Scholar5. Gorbenko K, Baim-Lance A, Franzosa E, et al. A national qualitative study of Hospital-at-Home implementation under the CMS Acute Hospital Care at Home waiver. J Am Geriatr Soc. 2023;71:245-258. [PMID: 36197021] doi:10.1111/jgs.18071 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David M. Levine, MD, MPH, MA; Jeffrey Souza, MA; Jeffrey L. Schnipper, MD, MPH; Thomas C. Tsai, MD, MPH; Bruce Leff, MD; Bruce E. Landon, MD, MBA, MScAffiliations: Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsHarvard Medical School; Department of Surgery, Brigham and Women’s Hospital; and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MassachusettsDivision of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Health Care Policy, Harvard Medical School, and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsNote: Dr. Levine and Mr. Souza had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analyses.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2264.Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Levine (e-mail, dmlevine@bwh.harvard.edu). Data set: Available with an approved data use agreement from the Research Data Assistance Center (https://resdac.org).Corresponding Author: David M. Levine, MD, MPH, MA, Harvard Medical School, Brigham and Women’s Hospital, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120; e-mail, dmlevine@bwh.harvard.edu.This article was published at Annals.org on 9 January 2024. PreviousarticleNextarticle Advertisement Annals Author Insight Video - David M. Levine, MD, MPH, MA In this video, David M. Levine, MD, MPH, MA, offers additional insight into the article, "Acute Hospital Care at Home in the United States: The Early National Experience." (Duration 3:10) FiguresReferencesRelatedDetails Metrics Latest Keywords Health care delivery Home hospitals Hospital medicine Inpatients ePublished: 9 January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...