Background: The Center for Medicare and Medicaid Services (CMS) enables Medicare-certified hospitals to provide inpatient-level care at home through their Acute Hospital Care at Home (AHCAH) initiative. A CMS report on 9/30/24 revealed demographic differences between AHCAH patients and traditional inpatients from the same hospitals. AHCAH patients were more likely to be white, live in urban areas, and less likely to be Medicaid recipients or receive low-income subsidies. Based on the findings reported by CMS, we sought to examine the demographic characteristics of patients participating in our institution’s Hospital at Home (HaH), to determine whether similar disparities in diversity are observed.
Methods: 744 unique patients were admitted to our Hospital at Home between 11/1/2023 and 10/31/2024. Demographic data is unavailable (unknown or patient declined) for 1% of those transferred into HaH, and these individuals were excluded. We analyzed the HaH patient demographics, including age, race/ethnicity, preferred language, and primary and secondary insurance providers. We then compared these results to the demographics of our institution’s Inpatients, brick-and-mortar patients, using the two-proportion z-test.
Results: HaH patient demographics: The analysis of patients transferred into HaH revealed the following demographic characteristics: mean age of 68 years; 28.1% self-identified as White, 20.2% as Black, 34.5% as Hispanic, 6.5% as Asian, and 10.8% as Other; 26% indicated a language preference other than English; and 19.6% of patients’ primary insurance is Medicaid, with 44.3% of patients covered by either primary or secondary Medicaid insurance. HaH patient demographics vs. our institution’s inpatient: A comparison of patient demographics between those enrolled in the HaH program and health system’s brick-and-mortar inpatient populations revealed different results to the CMS report. Regarding race/ethnicity, among inpatients, 36.3% identified as White, 13.6% as Black, 17.4% as Hispanic, 7.0% as Asian and 25.7% as Other, compared to HaH patients, where 28.1% identified as White, 20.2% as Black, 34.5% as Hispanic, 6.5% as Asian, and 10.8% as Other. Statistically, HaH had a significantly higher proportion of Hispanic patients (Z = 12.36, P < 0.001) and Black patients (Z = 5.28, P < 0.001) compared to the general inpatient population. Additionally, a language other than English was the indicated preference for 13% of inpatients but 26% of HaH patients, a statistically significant difference (Z = 7.47, P < 0.001). There was no statistically significant difference in the proportion of patients with primary Medicaid insurance, with 19.6% HaH patients and 17.8% inpatients (Z = 1.29, P = 0.197).
Conclusions: Our findings differ from the CMS report, with HaH demographics not only reflecting our health system’s overall demographics and high-need patient base, but also demonstrating a more diverse patient population in HaH compared to our health system. Our HaH patient population reflects the diversity of the neighborhood served by our institution and is accessible to individuals with limited resources. This demonstrates that it is feasible to provide care to diverse and low-resourced patient populations with Hospital at Home. One limitation to our analysis was that we were unable to compare primary and secondary Medicaid coverage due to lack of access to secondary insurance data for hospital inpatients. Future efforts should continue to enhance inclusivity to ensure HaH reaches those who need it most.