Background: Hospital-at-Home (HaH) programs represent an innovative model of healthcare delivery that has gained traction across the U.S. over the past decade. Multiple studies have shown that HaH provides comparable or superior 30-day mortality, readmission rates, and overall outcomes compared to traditional brick-and-mortar (BaM) hospitals. While HaH has been demonstrated to safely manage some acute urologic conditions, the characteristics and outcomes of patients with acute pyelonephritis treated in a HaH setting have not yet been described in the U.S.
Methods: We conducted a multicenter, retrospective cohort study of adult patients diagnosed with and managed for acute pyelonephritis within Mayo Clinic’s Advanced Care at Home (ACH) program between July 2020 and January 2025. Participants were drawn from Mayo Clinic in Florida, Mayo Clinic Health System in Eau Claire, and Mayo Clinic in Arizona. Data collected included demographics, Charlson Comorbidity Index (CCI), genitourinary comorbidities, severity of illness (SOI) and risk of mortality (ROM) scores. We also assessed the presence of sepsis, acute kidney injury (AKI), bacteremia, bacteriuria, and pyelonephritis-related complications. Outcomes included length of stay (LOS), escalation of care, and 30-day post-discharge emergency department (ED) visits, hospital readmissions, and mortality.
Results: A total of 165 patients met inclusion criteria. The median age was 67 years; 96 (58.2%) were female, and 140 (84.8%) identified as white. SOI scores were moderate in 55 (33.3%), major in 86 (52.1%), and extreme in 14 (8.5%). ROM scores were moderate in 50 (30.3%), major in 63 (38.2%), and extreme in 11 (6.7%). The median CCI was 5, and all patients had pre-existing genitourinary conditions. On admission, 51 patients (30.9%) met sepsis criteria, AKI was present in 78 (47.3%), and bacteremia developed in 55 (33.3%). The median LOS in the ACH program was 3.1 days. Only 8 patients (4.8%) required escalation to a BaM hospital. Within 30 days of discharge, 28 patients (17.0%) were readmitted, and 8 (4.8%) had ED visits. There were no in-program deaths.
Conclusions: This multicenter retrospective cohort study demonstrates that acute pyelonephritis, including patients with high severity of illness and complex comorbidities, can be managed safely and effectively in a HaH setting. These patients require inpatient-level care and are not appropriate candidates for outpatient infusion centers. The absence of mortality and low rate of care escalation highlight the potential of HaH to deliver high-acuity care at home, provided there is rigorous patient selection and a robust infrastructure to support timely and efficient escalation when needed.