Outcomes of 2,905 Hospital-at-Home Episodes: Clinical Effectiveness and Cost Savings
Overview
This large retrospective cohort study of 2,972 hospital-at-home (HAH) episodes in England demonstrated significant reductions in length of stay, 30-day readmissions, 90-day mortality, and healthcare costs compared with matched inpatient controls. The findings support the safety, clinical effectiveness, and cost-efficiency of HAH services for conditions including heart failure, airway disease, and acute respiratory infections.
Background
Hospital-at-home (HAH) models provide acute care in patients' homes as an alternative to traditional inpatient hospitalization. The COVID-19 pandemic accelerated HAH adoption in the UK to expand capacity and reduce hospital burden. Despite growing implementation, evidence on clinical outcomes and cost-effectiveness remains limited and sometimes conflicting. The West Hertfordshire Teaching Hospitals NHS Trust established a comprehensive HAH service in partnership with community providers, offering care pathways for heart failure, airway diseases, and acute respiratory infections. This study evaluates the real-world impact of this service over 33 months.
Data Highlights
Outcome
HAH vs Inpatient Control
Effect Size (95% CI)
p-value
Length of Stay (bed-day savings)
Reduced
3.13 days (2.60–3.67)
<1×10⁻²⁹
Total Bed-Day Savings
13,119 days
Net savings £3.79 million over 33 months
NA
30-day Readmission Rate
Lower
OR 0.55 (0.42–0.70)
<3×10⁻⁶
Total Hospital Time over 90 days
Reduced
2.64 days fewer (1.87–3.40)
<2×10⁻¹¹
90-day All-Cause Mortality
Lower
OR 0.43 (0.35–0.53)
<3×10⁻¹⁶
Key Findings
HAH reduced hospital length of stay by an average of 3.13 days compared to matched inpatient controls.
HAH care resulted in total bed-day savings of 13,119 days and net cost savings of £3.79 million over 33 months.
Total hospital time within 90 days from initial presentation was reduced by 2.64 days in the HAH group.
90-day all-cause mortality was significantly lower in the HAH cohort (OR 0.43), indicating potential mortality benefit.
The HAH service integrated remote monitoring and multidisciplinary care to replicate inpatient care safely at home.
Clinical Implications
Hospital-at-home services can safely reduce inpatient bed utilization and healthcare costs while improving patient outcomes such as readmissions and mortality. Clinicians should consider HAH as a viable alternative for appropriate patients with heart failure, airway diseases, and acute respiratory infections. Implementation requires robust remote monitoring and multidisciplinary coordination to ensure safety and effectiveness.
Conclusion
This large real-world evaluation confirms that hospital-at-home care is a clinically effective, safe, and cost-saving alternative to traditional inpatient hospitalization. These findings support broader adoption of HAH models within healthcare systems.
References
West Hertfordshire Teaching Hospitals NHS Trust et al. 2024 -- Outcomes of 2,905 Hospital-at-Home Episodes: A Propensity-Matched Cohort Analysis
by Michael Shaw, Batool Almogheer, Dominique Auger, Andrew Barlow, Balasmita Bhaskaran, Maria Buxton, Marco Cerulli, Kalpana Giri Ghimire, Edward Hiller, Zoe Jayne, Michal Kelly, Matthew Knight, Eleanor Zinkin, Niall G. Keenan
