SHM Converge Scientific Abstract ePoster Gallery-Comorbidity Burden Limits Effectiveness of Hospital at Home Early Support Discharge Intervention on 7 and 30-Day Unplanned Readmission and Mortality

Comorbidity Burden Limits Effectiveness of Hospital at Home Early Support Discharge Intervention on 7 and 30-Day Unplanned Readmission and Mortality

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This retrospective cohort study evaluated whether a Hospital-at-Home Early Supported Discharge (HaH ESD) model improved outcomes after discharge compared with routine discharge. Researchers analyzed 30,791 inpatient encounters across five hospitals in the southeastern U.S. between March 2024 and May 2025. Patients were discharged home or with home health from Hospital Medicine, General Internal Medicine, or Cardiology services.<br /><br />The HaH group (n=4,909) received an in-person HaH visit and virtual hospitalist follow-up after discharge. Compared with routine discharge (n=25,882), HaH patients were older and had greater illness burden, including higher Charlson Comorbidity Index scores, more prior healthcare use, and more frequent heart failure diagnoses. The median first HaH visit occurred 2 days after discharge, with about 2–3 total visits per patient.<br /><br />Unadjusted outcomes were worse in the HaH group: the combined rate of unplanned readmission or mortality was 7.8% at 7 days and 21.2% at 30 days, compared with 5.6% and 16.4% in routine discharge. After adjustment for age, comorbidities, length of stay, ICU stay, diagnosis group, and prior utilization, HaH remained associated with higher odds of the composite outcome at both 7 days (OR 1.27, 95% CI 1.03–1.57) and 30 days (OR 1.12, 95% CI 1.02–1.23).<br /><br />The study also found that the Epic 30-day readmission risk model underestimated actual readmission rates in this population, especially in mid-risk ranges.<br /><br />Overall, HaH ESD did not reduce short-term readmission or mortality and may be less effective in patients with higher comorbidity burden. The authors conclude that patient selection and outcome measurement are important when using HaH as a transition-of-care strategy.

Asset Subtitle

Brad Rowland

Meta Tag

Author List Brad Rowland, Corey Obermiller, Joseph Rigdon, Marc Kowalkowski, Thomas K. Houston

Category Research

Concept Hospital-at-Home Early Supported Discharge

Concept Readmission

Concept Charlson Comorbidity Index

Concept Care Transition

Concept Mortality

Distinguished Non-Finalist

Presenter Organization Wake Forest University School of Medicine

Presenting Author Brad Rowland

Track Transitions of Care

Keywords

Hospital-at-Home

Early Supported Discharge

readmission

mortality

retrospective cohort study

transition of care

comorbidity burden

virtual hospitalist follow-up

Epic readmission risk model

post-discharge outcomes

Hospital-at-Home Early Supported Discharge

Readmission

Charlson Comorbidity Index

Care Transition

Mortality