SHM Converge Scientific Abstract ePoster Gallery-Preliminary Evaluation of a Patient Selection Algorithm to Advance Clinical Decision Support for Hospital-at-Home Eligibility Decisions

Preliminary Evaluation of a Patient Selection Algorithm to Advance Clinical Decision Support for Hospital-at-Home Eligibility Decisions

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This study evaluated an electronic health record (EHR)-based algorithm to identify adults with suspected community-acquired pneumonia (CAP) who might be appropriate for hospital-at-home (HaH) care. HaH is presented as a safe, lower-cost alternative to traditional hospitalization, and the authors argue that clinical decision support may help expand its use.<br /><br />The project used a prospective cohort design over one month in 2021, before deployment of a clinical decision support application. Adults hospitalized through the emergency department were included if they had antibiotics ordered in the ED, chest imaging performed, low-to-moderate pneumonia severity risk, and no abnormal findings that would rule out HaH eligibility. The main outcome was in-hospital death; secondary outcomes included ICU admission within 72 hours and infection-related diagnosis.<br /><br />The cohort included 198 adults, with a median age of 74 years. About half were female, and most were White. Median pneumonia severity index was 92, with 47% classified as low risk and 53% as moderate risk. Median hospital length of stay was 4.2 days. Only 1% died in the hospital, and 3% required ICU admission within 72 hours. Most patients were discharged home, while 15% went to skilled nursing facilities. Infection-related diagnoses were common, including pneumonia and COVID-19.<br /><br />The authors conclude that few potentially eligible HaH patients experienced serious adverse outcomes, supporting the feasibility of using an EHR-based algorithm to select low-risk candidates for HaH. Based on early findings, they refined the approach to focus on patients for whom a pneumonia order set was initiated in the ED. Further evaluation is ongoing.

Asset Subtitle

Shih-Hsiung Chou

Meta Tag

Author List Amanda Aneralla, Andrew McWilliams, Benjamin Graham, Colleen Hole, Kelly Reeves, Marc Kowalkowski, Shih-Hsiung Chou, Stephanie Murphy, Tara Eaton

Category Research

Concept Home-Based Acute Care

Concept Community-Acquired Pneumonia

Concept Electronic Health Record

Concept Patient Selection Algorithm

Concept Pneumonia Order Set

Distinguished Non-Finalist

Presenter Organization Atrium Health

Presenting Author Shih-Hsiung Chou

Track Value in Hospital Medicine

Keywords

electronic health record

hospital-at-home

community-acquired pneumonia

clinical decision support

prospective cohort

emergency department

pneumonia severity index

hospitalization

patient eligibility

in-hospital mortality

Home-Based Acute Care

Community-Acquired Pneumonia

Electronic Health Record

Patient Selection Algorithm

Pneumonia Order Set