Outcomes in novel hospital-at-home model for patients with COVID-19: a multicentre retrospective cohort study

• Published in: Family practice 2023-12, Vol.40 (5-6), p.662-670
• Main Authors: Tsujimoto, Yasushi, Kobayashi, Masanori, Oku, Tomohisa, Ogawa, Takahisa, Yamadera, Shinichi, Tsukamoto, Masako, Matsuda, Noriya, Nishihira, Morikazu, Terauchi, Yu, Tanaka, Takahiro, Kawabata, Yoshitaka, Miyamoto, Yuki, Morikami, Yoshiki
• Format: Article
• Language: English
• Subjects: COVID-19 - therapy; Hospitalization; Hospitals; Humans; Retrospective Studies; Triage
• ISSN: 1460-2229; 1460-2229
• DOI: 10.1093/fampra/cmad010

Abstract Background Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with coronavirus disease (COVID-19). Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organized by a team of local primary care clinics. Methods We conducted a multicentre retrospective cohort study of the COVID-19 patients who received our HaH care from 1 January to 31 March 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka city were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. Results Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only 1 home visit in addition to online treatment. Conclusions The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.