A new study shows that hospital-level care is possible for adults living in rural areas, and those receiving acute care at home are more physically active than those receiving care in a brick-and-mortar hospital.
Rural patients also have a strong preference for acute care at home, according to a study published in JAMA Network Open, but the study did not find that home-based acute care reduces costs or readmissions compared to traditional hospital care.
“At (Rural Home Hospital) (RHH), there were no differences in costs or health care utilization, but patient experience and physical activity were significantly improved,” the study authors wrote. “It is important to place these results in the context of patients and policy makers. To our knowledge, there are few interventions that improve patient experience and physical activity without requiring higher costs.”
The study used data from a randomized clinical trial of 161 adults who visited the emergency department and required hospital-level care for specific acute symptoms. The study was conducted in three rural areas in the United States and Canada from 2022 to 2023.
Patients were divided into a home hospital group and a control brick-and-mortar hospital group. Patients in the home hospital group were less likely to be sedentary. According to accelerometer measurements, these patients were sedentary 78% of the day, compared to 86% of the day in the control group. They also took more steps each day. Home-based patients took an average of 834.1 steps per day, and controls took an average of 120.4 steps per day.
Patient experience also improved, with home hospital patients having an average Net Promoter Score of 88.4 and control group scores of 45.5.
Although the study found no improvement in costs or 30-day readmission rates for patients receiving home health services, the researchers' analysis suggested that costs and utilization would likely have improved if patients had been moved home sooner.
In addition to finding that rural home hospitals are feasible, the study also found that rural patients were more likely than urban patients to accept these services at home. A previous study found that patients in urban areas refused to enroll in home health services 63% of the time, but that number dropped to 31% for patients in rural areas.
Increased adoption of the home hospital model is hampered by the lack of long-term extension of home acute hospital care programs. Additionally, Inbound Health, one of the prominent operators in this space, recently closed down due to regulatory uncertainty.
A bipartisan bill seeking a longer extension passed the U.S. House of Representatives this week. The bill would extend the exemption for home hospitals until 2030.
