Acute care at home helps improve outcomes for rural patients

While most home hospital programs have so far been implemented in urban areas, a rural home hospital model, or RHH, has successfully delivered hospital-level care to patients living in rural areas without affecting costs, researchers say in a new study.

WHY IT MATTERS
One key focus with RHH is on increasing patient physical activity. During a randomized RHH clinical trial, acute care patients at home took more steps every day and had higher experience and satisfaction scores when compared to control groups of patients admitted to the hospital.

"We observed a larger acceptance of home hospital and better experience among rural patients," said researchers in their report published Monday in JAMA Network Open. "Rural patients were more accepting of the intervention, declining to enroll far less often (31%) than in our prior urban studies (63%)."

That means RHH could fill rural care gaps, according to the study's lead author, Dr. David Levine, Mass General Brigham's Healthcare at Home clinical director of research and development and director of Ariadne Labs’ Home Hospital Program. 

Similar to prior studies of urban hospital at home patients, this new rural RHH efficacy study demonstrated how hospital-level care delivered in patients’ homes lowered costs and improved patient outcomes and experiences.

The researchers focused on how rural acute care at home patients fared in terms of healthcare costs, 30-day readmission rates, physical activity levels and experience compared to those receiving care in traditional brick-and-mortar hospitals. 

The study – conducted from 2022 to 2023 at Blessing Hospital in Quincy, Illinois; Hazard Appalachian Regional Healthcare Regional Medical Center in Hazard, Kentucky; and Wetaskiwin Hospital and Care Centre in Alberta, Canada – included 161 adult patients. 

Those requiring hospital-level care for certain acute conditions – infections, heart failure, chronic obstructive pulmonary disease and other diagnoses – were recruited at the three hospitals' emergency departments, the researchers said in their report.

Patients in the home hospital group (79) received in-home nurse and/or paramedic visits, remote physician care, intravenous medications, remote monitoring, video communication and point-of-care testing. Emergency patients (82) admitted to the hospital received all their services there. 

Both groups had an average age of 64 and were predominantly women (52 in the RHH group and 50 for the inpatient group), white and had Medicare, Medicaid or a combination of both. One limitation of the study is that "few patients of other races and ethnicities lived in the surrounding counties" where the trials took place, the researchers noted.

All participants underwent a 30-day follow-up to assess their conditions and experiences. 

The length of care for each group was similar, with 6.7 days for the RHH group and 5.4 days for the hospital inpatient group. Six RHH group patients (7.6%) were transferred back to the hospital due to patient nonadherence to their protocols, worsening symptoms or a fall, the researchers said.

They found only minor variability in both cost and 30-day readmission rates across the groups. 

The adjusted mean cost of participants' acute episodes was 14% greater for inpatient care, and 30-day readmission rates were similarly insignificant, they said. 

Notably, utilization metrics favored RHH – adjusted mean costs per day were 49.4% less at home than for those in the study's hospital group.

Another key finding is that RHH patients "were more physically active and strongly preferred it over brick-and-mortar hospital care," the researchers said. "Patients in the home hospital group were less sedentary, according to accelerometer measurements."  

Those in the hospital spent more time sedentary – 86% of the day compared to 78% – while RHH patients took far more steps daily. The mean difference across study groups was 713.7 steps, according to the report.

They were also happier with their acute care at home. The rural RHH patients included in the study had better quantitative patient experience scores than their urban counterparts in prior studies. 

"Perhaps patients in rural areas experience much poorer access and quality care, and therefore appreciated the benefits much more than urban patients," the researchers said.

The researchers determined that RHH programs could potentially address healthcare gaps where rural hospitals have closed or where there is poor accessibility and transportation challenges.

"About 14% of U.S. residents and 18% of Canadians live in rural areas, totaling nearly 52 million people," the researchers noted. "For rural U.S. residents, 23% say access to healthcare is a major problem and a similar percentage report an average 34-minute drive to their nearest brick-and-mortar hospital."

"Rural healthcare is in a crisis, and we need to think differently," Levine said in an MGB announcement about the study.  

Six rural hospitals have closed thus far in 2025, according to online Rural Hospital Closures Maps maintained by the Cecil G. Sheps Center for Health Services Research at The University of North Carolina at Chapel Hill. Most recently, the only hospital in Glenn County, California, closed after losing its federal designation as a critical access hospital.

"Those particular areas that may have lost their hospital may be able to establish home hospital programs that are less expensive than brick-and-mortar care and employ clinicians that work locally," Levine said.

THE LARGER TREND
In September, 140 organizations urged Congress to extend the Acute Hospital Care at Home (AHCAH) waiver program under the U.S. Centers for Medicare and Medicaid, launched in 2020, by letter, pointing to reduced costs, lower mortality rates, fewer readmissions and less health spending post-discharge.

Then in October, New Jersey-based Virtua Health told Healthcare IT News that its hospital at home program demonstrated considerable value in terms of cost savings, outcomes, capacity and patient satisfaction. 

In part 1 of a three-part podcast series, the health system's chief information officer and president of advanced care operations explained how their program quickly evolved and which patient populations are the best fit.

In light of ongoing national dialogue for continued and permanent funding for hospital-level care at home, the new RHH study broadens the evidence base for continuing to fund home hospital programs, the researchers said.

It should "now include the one in five U.S. residents living in rural areas."

On Monday, the U.S. House of Representatives voted unanimously on legislation to extend acute hospital care at home. The Senate is expected to pass the measure, although the body has not specified a date for doing so. It must vote before Jan. 30, 2026, to avoid the current AHCAH waiver's expiration date.

ON THE RECORD
"In this randomized clinical trial of adults with acute illness living in rural areas requiring hospital admission, we showed home hospital was a feasible care model to deliver hospital-level care in a patient’s home," said researchers said in their report. "We observed a larger acceptance of home hospital and better experience among rural patients."