For Successful Hospital-at-Home Programs, Crucial Technologies Are Within Reach

Since 2016, hospital system Mass General Brigham (MGB) has delivered hospital-level care to more than 2,000 acutely ill patients in the comfort of their own homes, securing its place as a leader in the hospital-at-home (HaH) movement in the United States. A new article in NEJM Catalyst Innovations in Care Delivery highlights MGB's experience in developing and employing key technologies to better enable and enhance acute hospital care at home.

"There is good evidence that hospital-at-home care is safe, high quality, and cost-saving, and we are actively working to discover how current and emerging technologies will enhance this care," says first author Jared Conley, MD, Ph.D., MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital (MGH). "There is a growing understanding among patients, clinicians, and payors that better matching the provision of care to the best site of care represents the future of healthcare we are actively discovering ways to deliver more home-centered healthcare."

Since the inception of the HaH program five years ago, MGB has increased inpatient capacity of more than 10,000 bed-days. "Hospital-at-home frees brick-and-mortar hospitals to care for patients who need higher intensity care and, in the long term, we will need to build fewer hospitals," adds Conley. "It has been estimated that 15 percent to 30 percent of inpatient care could be delivered at home within the next 10 to 15 years."

Although Australia and some European countries have been providing hospital care at home for about three decades, only the Veterans Administration and a handful of large hospital systems in the U.S. have more recently taken on the complex challenges of developing this model of acute-care delivery. "The main barrier to the acceleration of this movement in the U.S. has been lack of adequate payment," says senior author David M. Levine, MD, MPH, MA, medical director of Strategy and Innovation for the Brigham Home Hospital.