From the Guidelines
Hospital at home (HAH) nurse programs are used to provide acute hospital-level care to patients in their own homes, delivering comprehensive medical care for conditions that would typically require hospitalization, including management of acute infections, chronic disease exacerbations, post-surgical care, and complex wound care. These programs are particularly beneficial for patients with chronic obstructive pulmonary disease (COPD) exacerbations, as they have been shown to be safe and effective in managing such conditions, with no significant differences in forced expiratory volume in 1 second (FEV1), mortality, or number of days in care between HAH and hospital care 1. HAH nurses administer medications, perform clinical assessments, monitor vital signs, provide treatments, and coordinate care with physicians and other healthcare providers. The programs often include daily nursing visits, remote monitoring technology, 24/7 on-call support, and access to diagnostic services.
Some of the key benefits of HAH programs include:
- Reducing hospital-acquired infections
- Improving sleep and mobility
- Decreasing delirium risk, especially in older adults
- Increasing patient satisfaction
- Maintaining clinical outcomes comparable to inpatient care These benefits are particularly valuable for elderly patients, those with mobility limitations, immunocompromised individuals, and patients with conditions that can be safely managed outside the hospital with appropriate nursing support and monitoring. According to the British Thoracic Society guideline, HAH should be offered to patients with exacerbations of COPD unless there is impairment of consciousness, confusion, acidosis, serious co-morbidity, or inadequate social support 1.
The role of intermediate care in stable COPD is not yet clearly defined, and initiatives in this area should be conducted as experimental and controlled interventions 1. However, for patients with acute COPD exacerbations, HAH programs have been shown to be effective in reducing the need for hospitalization and improving patient outcomes, as supported by the American Thoracic Society documents 1. Overall, HAH nurse programs are a valuable alternative to traditional hospital care, providing high-quality, patient-centered care in the comfort of the patient's own home, while maintaining clinical outcomes comparable to inpatient care.
From the Research
Hospital at Home Nurse Programs
Hospital at Home (HAH) nurse programs are designed to provide acute hospital-level care to patients in the comfort of their own homes. These programs aim to reduce hospitalizations, improve patient outcomes, and enhance the overall quality of care.
Purpose and Benefits
The primary purpose of HAH nurse programs is to:
- Provide hospital-level care to patients with acute medical conditions, such as community-acquired pneumonia, exacerbation of chronic heart failure, and cellulitis 2
- Reduce hospitalizations and readmissions by providing early outpatient care and home health visits 3
- Improve patient outcomes, including reduced mortality rates, fewer complications, and shorter lengths of stay 4, 2
- Enhance patient satisfaction with care, functional status, and quality of life 2
Key Components
HAH nurse programs typically involve:
- Medically-managed care, with a focus on acute medical and nursing treatment 4
- Hospital-level care, including intravenous antibiotic therapy, cardiac monitoring, and other advanced treatments 4, 2
- Nursing visits, with a mean of 9.3 visits per admission, and medical visits, with a mean of 4.1 visits per admission 4
- Collaboration with outpatient providers, home health agencies, and other healthcare stakeholders to ensure seamless transitions and comprehensive care 3, 5
Target Population
HAH nurse programs are often designed for:
- Older adults, aged 65 and older, with acute medical conditions 2, 3
- Patients with chronic conditions, such as heart failure, chronic obstructive pulmonary disease, and diabetes 2
- Patients who require hospital-level care but may not need to be hospitalized, such as those with community-acquired pneumonia or cellulitis 2
Outcomes and Effectiveness
Studies have shown that HAH nurse programs can:
- Reduce hospitalizations and readmissions, with a decrease in hospitalization rates from 61% to 38% before and after enrollment in a home-based primary care program 5
- Improve patient outcomes, with a reduced mortality rate of 0.15% and fewer complications 4
- Enhance patient satisfaction with care, functional status, and quality of life, with patients reporting high satisfaction rates and improved health outcomes 2