Background: Hospital-at-home programs deliver hospital-level care in the comfort of patients’ homes, offering an innovative alternative to traditional hospitalization. These programs have gained traction since the COVID-19 pandemic and Medicare’s expanded reimbursements for virtual visits. Studies have demonstrated that they effectively manage heart failure with outcomes comparable to traditional hospital care. In 2020, Kaiser Permanente (KP) San Bernardino County in Southern California adopted the Advanced Medical Care at Home (AMCAH) program, providing members an alternative to hospital admission. Outcomes from Kaiser AMCAH can improve future care delivery approaches for heart failure patients and transform the landscape of hospital medicine.
Methods: A retrospective cohort study of patients with a congestive heart failure diagnosis on ED presentation enrolled in the AMCAH program between January 2021 and September 2024. Approximately 15% of patients were enrolled from the ED, while 85% of patients were enrolled from hospital early discharges. The AMCAH enrollment criteria includes meeting InterQual criteria for hospitalization for heart failure, has KP Home Health benefits, and residing in AMCAH catchment area. Exclusion criteria include unstable arrhythmia, new onset atrial fibrillation, severe valvular disease, myocardial infarction within prior 4 weeks, pulmonary embolism, worsening renal function, dyspnea at rest after initial treatment, altered mentation. We evaluated the outcomes including 30-day return to Urgent Care/Emergency Department, 30-day readmission to the hospital, and 30-day mortality in this population of Heart failure patients enrolled in the AMCAH program.
Results: A total of 573 patients (39.4% female, 60.6% male, 60.5% Medicare recipients) with congestive heart failure were enrolled in AMCAH at KP San Bernardino Medical Center between January 2021 and October 2024. Racial/ethnic distribution was 41.4% White/Caucasian, 32.2% Hispanic/Latino, 19.0% Black, 6.0% Asian/Pacific Islander, and 1.4 % Other/Unknown. The average length of stay on AMCAH was 3.6 days in 2021, 2.8 days in 2022, 2.8 days in 2023, and 2.9 days in 2024. After AMCAH completion, 30-day return to Urgent Care/Emergency Department was 18.7% (107 patients), 30-day hospital readmission was 20.8% (119 patients). The 30-day mortality was 3.5% (20 patients).
Conclusions: Medicare data showed that the median risk-standardized 30-day readmission rate for heart failure treated with traditional hospitalization to be 23% and 1 year mortality is 35.8%. Our study demonstrated non-inferior outcomes for patients with heart failure enrolled in AMCAH at our medical center. There is also a notable decrease in average length of stay over the years since program inception. Further studies are warranted comparing outcomes for patients enrolled on AMCAH against controls receiving traditional hospitalization.
