Hospital at Home Versus Inpatient Care: Costs and Effectiveness

Background and Objectives Hospital at Home (HaH) delivers hospital-level treatment to acutely ill patients in their own homes, including daily medical and nursing visits, infusions, physiotherapy, and diagnostics. It bridges inpatient and outpatient care, working closely with hospitals, office-based physicians, home care services (Spitex), and therapy providers.

There are two main pathways:

Admission Avoidance: stable patients requiring hospitalization are admitted directly to HaH instead of an inpatient ward.

Early Supported Discharge: patients treated in hospital are discharged earlier than usual and transferred to HaH.

Evidence International studies show HaH to be safe and effective. Reviews report comparable mortality and rehospitalization, shorter hospital stays, and cost advantages. Admission avoidance is linked to trends toward lower mortality and costs. Research showed similar mortality but fewer rehospitalizations, longer treatment duration, and reduced risks of institutionalization, depression, and anxiety. HaH patients were older, with reduced daily living activities, yet care costs were on average USD 5,054 lower than inpatient care.

In Switzerland, the mean hospital stay in 2019 was 8 days (acute somatic: 5.2; psychiatry: 33.5).

Study Hypotheses

HaH can be delivered at equal or lower cost than regular hospitalization.

HaH care is safe, with few complications, and yields high patient satisfaction.

Study Objective To demonstrate that hospital-equivalent home treatment of acutely ill patients is effective, appropriate, cost-efficient (according to Swiss WZW criteria), safe, and associated with high satisfaction and low complication rates compared with inpatient care.

Endpoints

Primary: Costs - HaH vs. inpatient care at Hirslanden Clinic, using REKOLE® cost accounting.

Secondary: Mortality, therapy type, monitoring, diagnostics, rehospitalization, complications, satisfaction, patient-reported outcomes, length of stay, referrals to nursing homes, follow-up after discharge, ED visits, rehabilitation referrals, and home care type.