Identifying Optimal Acute Care Comparators to Inform the Evaluation of an Advanced Care at Home Pilot Program

Abstract

Background: Hospital at Home (H@H) programs-which seek to deliver acute care within a patient's home-have become more prevalent over time. However, existing literature exhibits heterogeneity in program structure, evaluation design, and target population size, making it difficult to draw generalizable conclusions to inform future H@H program design.

Objective: The objective of this work was to develop a quality improvement evaluation strategy for a H@H program-the Kaiser Permanente Advanced Care at Home (KPACAH) program in Northern California-leveraging electronic health record data, chart review, and patient surveys to compare KPACAH patients with inpatients in traditional hospital settings.

Methods: The authors developed a 3-step recruitment workflow that used electronic health record filtering tools to generate a daily list of potential comparators, a manual chart review of potentially eligible comparator patients to assess individual clinical and social criteria, and a phone interview with patients to affirm eligibility and interest from potential comparator patients.

Results: This workflow successfully identified and enrolled a population of 446 comparator patients in a 5-month period who exhibited similar demographics, reasons for hospitalization, comorbidity burden, and utilization measures to patients enrolled in the KPACAH program.

Conclusion: These initial findings provide promise for a workflow that can facilitate the identification of similar inpatients hospitalized at traditional brick and mortar facilities to enhance outcomes evaluations for the H@H programs, as well as to identify the potential volume of enrollees as the program expands.

Figure 1:

Workflow diagram for identifying eligible comparators from a daily automated list of patients meeting EHR criteria between September 2, 2021, and February 4, 2022. ED = emergency department; EHR = electronic health record; IP = inpatient; KPACAH = Kaiser Permanente Advanced Care at Home.

Figure 2:

Cumulative number of eligible comparator patients identified via the Acute Substitution and Early Discharge pathways between September 2, 2021, and February 4, 2022. The Early Discharge approach started November 4, 2022, and comprised 28% of the comparators. Acute Sub = the Acute Substitution or Admission Avoidance program completely substitutes for an inpatient hospital stay from the ED; Early Discharge = the Early Discharge program facilitates a reduction in inpatient length of stay.