Jeremy M. Jacobs, MBBS, BSc; Robert Hammerman-Rozenberg, MD; Jochanan Stessman, MD
Potential Financial Conflicts of Interest: None disclosed.
Jacobs J., Hammerman-Rozenberg R., Stessman J.; Home Hospitalization: 15 Years of Experience. Ann Intern Med. 2006;144:456. doi: 10.7326/0003-4819-144-6-200603210-00023
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Published: Ann Intern Med. 2006;144(6):456.
TO THE EDITOR:
We read with interest the report by Leff and colleagues on hospital at home (1). Their findings that hospital at home led to shorter length of stay, fewer medical complications, greater patient satisfaction, and reduced cost are important additions to the evidence supporting this service. They are also similar to our experience with the Jerusalem Home Hospital program, which, since its initiation in 1991, has treated more than 13 000 patients with intensive medical, subacute, and palliative care at home instead of in the hospital.
We previously reported that decreased hospital utilization was attributable to the establishment of our home hospital service (2, 3). Recent data confirmed these findings. When the chief administrator of our health maintenance organization (HMO) cut home hospital spending by 60% (a reduction from 400 to 150 patients treated simultaneously), it allowed our institution to monitor the impact of withdrawing this service on geriatric and medical hospitalization rates. An analysis of 45 000 HMO beneficiaries older than 65 years of age showed that per capita patient days and spending increased rapidly in the 12 months after the home hospital budget was cut, far exceeding forecasts based on previous trends. Hospital days in medical wards increased by 7.2% in contrast to a projected decline of 2.9%, and days in geriatric wards increased by 16.9% as opposed to a forecasted rise of 4.4%. On the basis of these data, the previous home hospital budget at our institution was restored.
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