Home Hospital for Suddenly Ill Adults
1 other identifier
interventional
3,000
1 country
2
Brief Summary
The investigators propose a home hospital model of care that substitutes for treatment in an acute care hospital. Limited studies of the home hospital model have demonstrated that a sizeable proportion of acute care can be delivered in the home with equal quality and safety, reduced cost, and improved patient experience.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jan 2018
Longer than P75 for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
Study Start
First participant enrolled
January 18, 2018
CompletedFirst Submitted
Initial submission to the registry
May 2, 2018
CompletedFirst Posted
Study publicly available on registry
May 14, 2018
CompletedPrimary Completion
Last participant's last visit for primary outcome
September 1, 2030
ExpectedStudy Completion
Last participant's last visit for all outcomes
September 1, 2031
March 17, 2026
March 1, 2026
12.6 years
May 2, 2018
March 16, 2026
Conditions
Outcome Measures
Primary Outcomes (1)
Total direct cost of hospitalization, $
From date of admission to date of discharge, an expected average of 4 days
Secondary Outcomes (28)
Direct margin, $
From date of admission to date of discharge, an expected average of 4 days
Direct margin, modeled with backfill
From date of admission to date of discharge, an expected average of 4 days
Total cost, 30-day post discharge
Day of admission to 30-days post-discharge
Length of stay, days
From date of admission to date of discharge, an expected average of 4 days
Imaging, #
From date of admission to date of discharge, an expected average of 4 days
- +23 more secondary outcomes
Other Outcomes (63)
Total reimbursement, 30-days post discharge
Day of admission to 30-days post-discharge
Intravenous medications, days
From date of admission to date of discharge, an expected average of 4 days
Intravenous fluids, days
From date of admission to date of discharge, an expected average of 4 days
- +60 more other outcomes
Study Arms (1)
Home Hospitalization
EXPERIMENTALPatients will return home after triage, diagnosis, and the beginning of treatment in the emergency department with a set of specialized patient-tailored services (listed above). On discharge and 30 days after discharge, they will be interviewed regarding their hospitalization and health.
Interventions
Eligibility Criteria
You may qualify if:
- Resides within either a 5-mile or 20 minute driving radius of emergency department
- Has capacity to consent to study OR can assent to study and has proxy who can consent
- \>= 18 years-old
- Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
- Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.
You may not qualify if:
- Undomiciled
- No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
- On methadone requiring daily pickup of medication
- In police custody
- Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
- Domestic violence screen positive
- Acute delirium, as determined by the Confusion Assessment Method
- Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
- Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
- Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
- Cannot independently ambulate to bedside commode
- As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
- High risk for clinical deterioration
- Home hospital census is full (maximum 5 patients at any time)
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
Brigham and Women's Hospital
Boston, Massachusetts, 02115, United States
Brigham and Women's Faulkner Hospital
Boston, Massachusetts, 02130, United States
Related Publications (7)
Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, Greenough WB 3rd, Guido S, Langston C, Frick KD, Steinwachs D, Burton JR. 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 Dec 6;143(11):798-808. doi: 10.7326/0003-4819-143-11-200512060-00008.
PMID: 16330791BACKGROUNDCryer L, Shannon SB, Van Amsterdam M, Leff B. Costs for 'hospital at home' patients were 19 percent lower, with equal or better outcomes compared to similar inpatients. Health Aff (Millwood). 2012 Jun;31(6):1237-43. doi: 10.1377/hlthaff.2011.1132.
PMID: 22665835BACKGROUNDHung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) service. JAMA Intern Med. 2013 Jun 10;173(11):990-6. doi: 10.1001/jamainternmed.2013.478.
PMID: 23608775BACKGROUNDFong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009 Apr;5(4):210-20. doi: 10.1038/nrneurol.2009.24.
PMID: 19347026BACKGROUNDCounsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc. 2000 Dec;48(12):1572-81. doi: 10.1111/j.1532-5415.2000.tb03866.x.
PMID: 11129745BACKGROUNDMontalto M. The 500-bed hospital that isn't there: the Victorian Department of Health review of the Hospital in the Home program. Med J Aust. 2010 Nov 15;193(10):598-601. doi: 10.5694/j.1326-5377.2010.tb04070.x.
PMID: 21077817BACKGROUNDLevine DM, Ouchi K, Blanchfield B, Diamond K, Licurse A, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. J Gen Intern Med. 2018 May;33(5):729-736. doi: 10.1007/s11606-018-4307-z. Epub 2018 Feb 6.
PMID: 29411238BACKGROUND
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- NA
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- SINGLE GROUP
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- David M Levine, MD, MPH, MA, Associate Physician, Brigham and Women's Hospital
Study Record Dates
First Submitted
May 2, 2018
First Posted
May 14, 2018
Study Start
January 18, 2018
Primary Completion (Estimated)
September 1, 2030
Study Completion (Estimated)
September 1, 2031
Last Updated
March 17, 2026
Record last verified: 2026-03
Data Sharing
- IPD Sharing
- Will not share