Abstract
Background: The Complex Care Hub (CCH) program in Calgary, Canada is based on the international hospital at home model. CCH was co-designed with an inter-professional, inter-organizational team spanning the healthcare system in Calgary, Canada. Throughout this process we also involved patient advisors to support development of materials and processes impacting patient care and transitions across the system.
Approach: The program evaluation leveraged the Quadruple Aim framework via a multi-methods study that included patient, caregiver and provider surveys and interviews, as well as quantitative data analysis on patient outcomes, healthcare utilization and cost. This included a comparison of CCH patients with retrospective propensity-matched controls, on the basis of demographic and clinical factors. For data from 2018-2020, 241 of 278 CCH patients were matched to contemporaneous controls, and 238 were matched to historical controls at the same site. Currently, the same analysis is being conducted for admissions between 2020-2023.
Results: CCH patients and caregivers reported an overall high quality of care on CCH. In the 2 years prior to the pandemic, patients' average rating of CCH care was 9.3 out of 10 (n=169). Of CCH patients surveyed during the COVID-19 pandemic (n=91), 97% of patients (n=91) were ""satisfied"" or ""very satisfied,"" 100% reported that they were treated with ""respect and dignity,"" and 80% felt prepared to manage their conditions upon discharge. Health-related quality of life measured by the EQ-5D visual analogue scale found an average improvement of 9.8 points from admission (n=148) to 30 days post discharge.
Length of stay (in days) appeared to be twice as long for CCH patients versus controls. However, when separating by subgroups, the AA group showed no statistically significant difference in length of stay, while the EFD subgroup had a statistically significant increase in length of stay over twice that of controls. AA subgroup cost estimates suggest 35% lower cost of index admissions, with a further avoidance of 13% in the 180 days post-dishcarge with an overall reduction in cost of 22%. EFD subgroup showed 78% higher cost during the index admissions (approximately $19700 versus $11000 for controls) with but showed a dramatic cost avoidance of 65% in the 180 days post-discharge ($15800 versus $24000) with an overall equal cost over 6 months in both arms. When all patients were analyzed together, the same pattern was observed as for the EFD subgroup, which comprised 75% of admissions. At the time of writing this abstract the analysis for data from 2020 to 2023 is in progress and expected to be completed for ICIC 2025.
Implications: Hospital at Home is an emerging international model of care that is able to safely provide home-based acute care and enhance transitions of care via real-world care-planning. The ability to care for patients outside of hospital walls increases system capacity, with better patient and caregiver experience and outcomes, while reducing the need to build new physical infrastructure.