Hospitalization at Home: The Acute Care Home Hospital Program for Adults

Completed · Not applicable

Conditions studied: Pneumonia, Heart Failure, Cellulitis, Urinary Tract Infections

In brief

The investigators propose a home hospital model of care that substitutes for treatment in an acute care hospital. Limited studies of the home hospital model have demonstrated that a sizeable proportion of acute care can be delivered in the home with equal quality and safety, reduced cost, and improved patient experience.

Key facts

Study ID

NCT02864420

Run by

Brigham and Women's Hospital

People needed

21

Starts

2016-09-01

Expected to finish

2016-12-01

Last updated by the study team

2017-07-11

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Resides within 5-mile radius of emergency room
• English- or Spanish-speaker
• Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him.
• This criterion may be waived for highly competent patients at the patient and clinician's discretion.
• >=18 years old
• Primary diagnosis of cellulitis, heart failure, complicated urinary tract infection, or pneumonia that requires inpatient admission as determined by blinded emergency room team.

You may not qualify if…

• Undomiciled
• No working heat (October-April), no working air conditioning if forecast > 80°F (June-September), or no running water
• On methadone requiring daily pickup of medication
• In police custody
• Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
• Domestic violence screen positive
• Cared for by a private primary care physician who rounds in the hospital
• Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
• Secondary condition: active non-melanoma/prostate cancer, end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
• Primary diagnosis requires narcotics for pain control
• Cannot independently ambulate to bedside commode
• As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
• For pneumonia:
• Most recent CURB65 > 3: new confusion, blood urea nitrogen > 19mg/dL, respiratory rate>=30/min, systolic blood pressure<90mmHg, Age>=65
• Most recent SMRTCO > 2: systolic blood pressure < 90mmHg (2pts), multilobar chest xray involvement (1pt), respiratory rate >= 30/min, heart rate >= 125, new confusion, oxygen saturation <= 90%
• Absence of clear infiltrate on imaging
• Cavitary lesion on imaging
• O2 saturation < 90% despite 5L O2
• For heart failure:
• Has a left ventricular assist device or paced rhythm
• Get with the Guidelines - Heart Failure (>10% in-hospital mortality) or The Acute Decompensated Heart Failure National Registry score (high risk or intermediate risk 1)
• Anasarca
• Pulmonary hypertension
• For complicated urinary tract infection:
• Absence of pyuria

Where it is running

• Brigham and Women's Hospital — Boston, Massachusetts, United States
• Brigham and Women's Faulkner Hospital — Boston, Massachusetts, United States

Full record on ClinicalTrials.gov

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