Transition of care marks a critical period for patients as they move between different healthcare settings with varying levels of care. Post Acute Care Program services are specifically designed to support patients with complex ongoing needs as they are discharged from hospitals to home-based or community environments. This transition is inherently risky, with potential for medical errors and adverse events arising from communication breakdowns, particularly during patient handoffs between different organizations and home-based healthcare providers.1,2 Alarmingly, about one in five hospitalized patients face readmission within 30 days, and this number climbs to one-third within 90 days.3,4 A comprehensive review of 54 high-quality studies highlighted that roughly half of older adults transitioning from hospitals to community settings experience at least one medical error, and 20% suffer from one or more adverse events.1 Patients from lower socioeconomic backgrounds are particularly vulnerable to negative outcomes like medication errors, injuries, and increased hospital readmission rates.5,6 Furthermore, diagnostic errors, including missed, delayed, or incorrect diagnoses, represent a significant but often overlooked concern within home-based primary care settings.7 While this issue is recognized in office-based primary care,8-10 its prevalence in home-based primary care remains understudied.
Home-based care programs are equipped to receive patients discharged from hospitals, whether they return to their private homes, assisted living facilities, or residential care settings. Defined by the World Health Organization (WHO), home-based care encompasses a range of services delivered at a person’s residence, including physical, psychosocial, and palliative care.11 These services can range from round-the-clock support to intermittent assistance for elderly individuals, people with disabilities, or those requiring extended post-hospitalization care.12 Despite the recognized benefits, home-based care is not without its challenges. Issues such as ineffective handoffs, incomplete clinical information transfer, and medication errors have been reported.2 However, numerous studies indicate that home-based care, when grounded in evidence-based practices, can provide a safe, effective, and appropriate extension of medical services beyond the confines of traditional hospitals and clinics.13 To this end, stakeholders have developed a robust three-category quality model, encompassing provider and practice activities, provider characteristics, and patient, provider, and caregiver outcomes, which includes 10 domains and 49 specific standards of care.14 Unfortunately, research utilizing this comprehensive framework remains limited.
Types of Home-Based Post Acute Care Programs
Home-based care programs, including post acute care programs, can be broadly classified into three main categories based on the services they offer and the patient’s functional and medical objectives:
- Custodial Care: This is the most extensive segment of home-based care. In 2020, it was estimated that over 53 million Americans (21.3%) were informal caregivers for a child or adult. More than half of these caregivers provide care to 5.5 million adults, with 3.6 million of those adults suffering from dementia.15,16 Custodial care can be provided by unpaid individuals like family and friends or by trained paid caregivers.
- Home Health Agencies (HHAs): HHAs employ licensed visiting nurses, home health aides, and physical, occupational, and speech therapists who deliver care within the patient’s home.
- Home-Based Primary Care (HBPC): HBPC is delivered by physicians or advanced practice providers such as nurse practitioners, physician assistants, and pharmacists directly in the patient’s residence.
These interprofessional team-based care programs, integral to effective post acute care, are designed to prioritize patient safety, foster independence, and ultimately reduce unnecessary hospitalizations or emergency department visits, thereby lowering overall healthcare costs. Home-based care, especially within post acute care programs, primarily focuses on patients with chronic illnesses or functional frailty who are at a higher risk of patient safety incidents like medication errors, falls, and other adverse events. The intensity of home-based care can vary significantly, ranging from low-acuity chronic care with minimal provider involvement to high-acuity acute care requiring substantial provider engagement.
This discussion will further explore patient safety concerns and care strategies within Home Health Agencies (HHAs) and other home-based programs, crucial components of the broader post acute care program landscape. We will also review best practice recommendations aimed at enhancing care quality and minimizing adverse events in these settings.
Formal Home-Based Post Acute Care Programs
Home Health Agency Services within Post Acute Care
HHAs stand as the largest providers of home-based care services, including vital post acute care program elements, delivering both skilled and unskilled care within patients’ residences. HHA services encompass medical and personal care provided by professional nursing and rehabilitation staff, as well as non-professional home health aides, all within the patient’s place of residence.17 To qualify for HHA services as part of a post acute care program, patients must meet three key criteria:
- Be under the care of a physician or qualified provider.
- Have had a face-to-face encounter with their provider within the 90 days before care begins or within 30 days after care initiation.
- Be considered homebound.
The Centers for Medicare & Medicaid Services (CMS) defines “homebound” as being restricted to the home due to illness or injury. To meet the homebound criteria, a patient must satisfy one of two conditions: (1) require assistive devices or personal assistance to leave their home; or (2) leaving home is medically contraindicated. Once one of these conditions is met, the provider must further certify that (1) leaving home would demand considerable and taxing effort; and (2) leaving home would impose an unusually burdensome experience on the patient.2
Furthermore, providers must certify that the patient requires intermittent complex care that can only be delivered by qualified licensed nurses or therapy clinicians, and that the qualifying condition is expected to improve within a reasonable timeframe.
Referrals to HHAs, a key component of post acute care programs, are made at the provider’s discretion, leading to significant variations in referral practices. This variability can result in some patients not receiving necessary home health services.18 Wider adoption of clinical assessment tools that incorporate relevant clinical and nonclinical information, such as caregiver status, could mitigate this issue. Standardized tools can facilitate more consistent, efficient, and evidence-based referral processes, reducing the risk of adverse events and optimizing post acute care program effectiveness.18
In 2020, there were 11,221 HHAs in operation, with nearly 81% being for-profit entities.19 Studies have indicated that for-profit HHAs tend to have higher costs ($4,827 vs. $4,075 per episode) and may deliver lower quality care compared to not-for-profit agencies,20 particularly concerning rehospitalization rates.21 To uphold quality and patient safety within post acute care programs, HHAs undergo national accreditation by organizations like The Joint Commission, Accreditation Commission for Health Care, and the Community Health Accreditation Program.22 They are also surveyed by accrediting and state agencies approximately every three years.23 CMS certification is mandatory for HHAs to accept Medicare patients. Each HHA submits comprehensive patient care data (Outcome and Assessment Information Set or OASIS) to CMS for quality reporting, which is publicly available on the Care Compare website. Ratings include measures such as patient improvement, medication education, unplanned ED visits, hospital admissions/readmissions, and community retention post-discharge from home health – all critical indicators of post acute care program success.
A study analyzing over 17 million hospitalizations compared patient outcomes for those discharged to skilled nursing facilities versus home health. It found a higher 30-day readmission rate for patients discharged to home health, but at a lower cost of care, with no significant differences in functional outcomes or mortality.24 Patients discharged from hospitals to HHA care account for a substantial portion (25%) of infection-related hospital readmissions.25,26 For instance, a study of 28,205 home health care patients with urinary catheters revealed that inadequate policies led to a 21% increased likelihood of hospital transfer due to urinary tract infections.27 Another study demonstrated that HHAs failing to provide necessary family caregiver training resulted in nearly double the number of acute care hospitalizations.28 Similarly, older research on hospital readmissions after hip fracture, COPD, pneumonia, stroke, and CHF showed readmission rates ranging from 12%-23% at 30 days and 18-34% at 60 days. These readmissions were linked to variations in practice styles, local regulations, and service availability.29 A recent systematic review identified heart failure patients as having the highest readmission rates due to symptom exacerbations. Other risk factors for readmission included older age, Black race, poor health status, illness severity, comorbidities, living alone, fewer home health aide visits, and other vulnerabilities.30 These findings underscore some of the risks of adverse events associated with patients receiving home health care within post acute care programs.
Efforts to enhance home health care, particularly within post acute care programs, are ongoing, focusing on improving value, team-based care, care coordination across settings, technology utilization, and population health management.31 For example, CMS has implemented a pilot Home Health Value-Based Purchasing (HHVBP) program, expanded in 2022, to incentivize HHAs to shift from volume-based care to value-driven, high-quality care delivery.32 A study on patient safety and adverse events in home care for older adults with diabetes reported higher readmissions related to reduced self-care abilities (due to functional decline or cognitive impairment), suboptimal agency care approaches (failure in patient education and self-care training), and lack of annual condition reviews.33 Research has indicated that increased registered nurse staffing and team-based approaches, including integrated practice in home care and post acute care programs, show promise in improving patient outcomes.34-37
Home-Based Primary Care in Post Acute Care Programs
Home-Based Primary Care (HBPC) was initially developed for veterans requiring team-based, in-home support for chronic conditions impacting their health and daily lives.38 Veterans meeting these criteria often struggle to attend clinic visits due to the severity of their conditions and are frequently homebound. HBPC programs have expanded beyond veterans, evolving into modern-day house call programs, which have become increasingly relevant in post acute care. The “house call” concept, common in the 1930s when 40% of U.S. healthcare was home-based, is experiencing a resurgence.
Modern “house calls” via HBPC deliver primary care specifically to the most medically complex, homebound, or home-limited patients who face challenges in obtaining follow-up care, perpetuating cycles of poor health management and high costs.39 The rise of health information technology has significantly fueled the resurgence of home-based care and post acute care programs. Electronic medical records enable virtual access to patient charts. Portable x-ray and ultrasound equipment are readily available, and smartphones can now function as electrocardiograms, ultrasound consoles,40 medical reference portals (textbooks, drug databases41), and tools for transmitting paperwork with remote scanning and printing capabilities42. The growth of nurse practitioners (NPs) has further facilitated HBPC expansion within post acute care programs,43,44 with most HBPC practices adopting a multidisciplinary approach. A wide range of Medicare-covered services are available during HBPC visits, including patient evaluation and management, chronic care management, transitional care management, Medicare annual wellness exams, and advance care planning. A 2016 systematic review of HBPC for adults with serious illnesses found that HBPC was associated with fewer hospitalizations and shorter lengths of stay, with frail or sicker patients benefiting most significantly from HBPC services within post acute care programs.45
Independence at Home as a Post Acute Care Model
Independence at Home (IAH) is a specialized home-based care service, often considered a model post acute care program, designed for frail, homebound older adults. It originated as a CMS Innovation Center demonstration project.46 Through the IAH Demonstration, the CMS Innovation Center collaborated with select medical practices nationwide to assess the effectiveness of delivering comprehensive primary care to Medicare beneficiaries with multiple chronic conditions in their homes.47 Practices participating in the project, which delivered high-quality care while reducing costs, were eligible for financial rewards through the IAH Demonstration. IAH services target fee-for-service beneficiaries with at least two chronic conditions, who require assistance with two activities of daily living, have been hospitalized in the past 12 months, and are not in long-term care or hospice at enrollment. Participating practices conduct tailored in-home visits and coordinate patient care.
The Commonwealth Fund report, “An Overview of Home-Based Primary Care: Learning from the Field,” highlights key insights and lessons from home-based primary care, including its role in post acute care programs.48 Notably, the report indicates that less than 12% of homebound individuals receive any primary care services, and traditional office visits are often inadequate for this population’s complex needs. Best practices in the IAH model include interdisciplinary teams, longer, more comprehensive appointments, integrated behavioral health and social support, and enhanced care coordination through regular team meetings. The IAH model incentivizes practices based on shared cost savings, making it a financially sustainable post acute care program.
Despite some positive outcomes in the initial five years of the IAH Demonstration, evidence supporting the hypothesis that IAH payment incentives significantly reduced Medicare spending or improved care quality for chronically ill, functionally limited beneficiaries has been limited. In Year 5, payment incentives were linked to lower Medicare expenditures, but these results were largely attributed to a single site that subsequently discontinued home-based primary care.48 The most recent data (2019) indicated only a $41 per beneficiary per month reduction in Year 6, which was not statistically significant.49 Furthermore, there was no evidence that IAH reduced ED visits or hospital admissions, and only six of nine practices met required quality standards, and even then, for only half of the required measures. Despite these mixed results, certain subgroups appear to benefit from IAH services, including those needing improved access to regular primary care and individuals near the end of life who benefit from less aggressive care. The program has received multiple extensions, with the latest in December 2020, extending it for three additional years, scheduled to end in 2023 unless reauthorized, highlighting the ongoing interest in IAH as a post acute care program model.
Hospital at Home: An Innovative Post Acute Care Program
Hospital at Home (HaH) represents an innovative post acute care program model that enables healthcare organizations to deliver high-quality, hospital-level care to acutely ill, primarily older adults in their homes. HaH aims to improve patient outcomes, shorten hospital stays, enhance patient experience, and reduce healthcare costs, potentially by 19% to 30% compared to traditional inpatient care.50 HaH serves as a complete substitute for acute hospital care. It has been implemented across numerous U.S. sites by VA hospitals, healthcare systems, home care providers, and managed care programs. HaH programs differ from standard home health services; HaH patients must meet hospital-level service criteria and require daily physician rounding and continuous medical team monitoring in their homes. Hospital care at home services leverage telehealth, remote monitoring, and regular in-person nurse visits to deliver care to acutely ill patients in their homes as part of a comprehensive post acute care program.15
According to DeCherrie and colleagues, HaH is associated with enhanced quality, improved patient safety, better patient and family care experiences, and reduced costs for appropriately selected patients within post acute care programs.51 A 2018 case-controlled study comparing HaH patients to similar patients not receiving HaH services found that HaH patients experienced shorter hospital stays, lower odds of hospital or ED readmission, and improved patient care experiences.52 However, other studies have not consistently shown lower readmission rates,53 and have highlighted medication-related issues and adverse drug events. Some studies also provide limited data on patient mortality. An earlier meta-analysis of 61 randomized controlled trials reported reduced mortality, lower readmission rates, and increased patient and caregiver satisfaction with HaH programs.54 Furthermore, a meta-analysis focusing on integrating pharmacists into hospital-to-home transitions within post acute care programs has demonstrated a positive impact on medication safety.55,56 Ongoing challenges for HaH programs include the lack of a clear regulatory framework, necessary modifications to electronic health records, and payment and billing complexities, all of which are being addressed to further solidify HaH as a viable post acute care program model.55,56
Conclusion: The Future of Post Acute Care Programs
Home-based care programs, particularly post acute care programs, are crucial for effectively managing patients transitioning from acute care settings to their homes and for preventing hospitalizations when care can be safely delivered at home. Rising healthcare costs, patient preferences for home-based care, and the well-documented risks of hospitalization (nosocomial infections, delirium, adverse events) are driving increased demand for these programs.57 As more patients seek care in the comfort of their homes, alternatives to traditional post-acute hospital care continue to be explored. However, it is paramount that these alternatives demonstrate the delivery of high-quality and safe care. Post acute care programs are at the forefront of this evolution, striving to balance patient preference with clinical excellence and safety.
Vanessa McElroy, MSN, PHN, ACM-RN, IQCI
Director, Care Transition and Population Health Care Management
UC Davis Health
[email protected]
Ron Billano Ordona, DNP, FNP-BC, GS-C
Health Sciences Assistant Clinical Professor
Betty Irene Moore School of Nursing
UC Davis Health
[email protected]
Deb Bakerjian PhD, APRN, FAAN, FAANP, FGSA
Co-Editor-in-Chief, AHRQ’s Patient Safety Network (PSNet)
Clinical Professor
Betty Irene Moore School of Nursing
UC Davis Health
[email protected]
References
[1] transitions-care) services involve discharging patients with ongoing complex care needs from the hospital to a home-based or community care environment. This period carries a high risk of medical errors and adverse events due to fragmented communication including failure to complete safe handoffs and the need to integrate between a number of organizations and home-based and community health care providers.[1,2] Approximately one in five hospitalized patients are readmitted within 30 days and a third of patients are readmitted in 90 days.[3,4] A recent systematic review of 54 moderate to high-quality studies found that about half of older adult patients transitioning from the hospital to community settings were affected by at least one medical error and 20% were affected by one or more adverse events.[1] Patients with low socioeconomic status are at particularly high risk for poor outcomes such as medication errors, injuries, and higher hospital readmission rates.[5,6] An important, but underemphasized, area of concern in home-based primary care is diagnostic error, including missed diagnosis, delayed diagnosis, and wrong diagnoses.[7] While this has been shown to be problematic in office-based primary care,[8-10] it has not been studied in home based primary care settings.
[2] home-based care such as ineffective handoffs, limitations in clinical information, and medication errors.[2] Despite those challenges, some studies have shown that home-based care can provide patients an effective, safe, and appropriate continuation of medical services beyond the traditional care provided within hospital and clinic walls if evidence-based practices are followed.[13] In fact, a group of stakeholders has developed a three-category quality model (provider and practice activities; provider characteristics; and patient, provider, and caregiver outcomes) with 10 domains and 49 standards of care.[14] Unfortunately, as yet, little research has been done using this framework.
[3] Approximately one in five hospitalized patients are readmitted within 30 days and a third of patients are readmitted in 90 days.[3,4]
[4] Approximately one in five hospitalized patients are readmitted within 30 days and a third of patients are readmitted in 90 days.[3,4]
[5] Patients with low socioeconomic status are at particularly high risk for poor outcomes such as medication errors, injuries, and higher hospital readmission rates.[5,6]
[6] Patients with low socioeconomic status are at particularly high risk for poor outcomes such as medication errors, injuries, and higher hospital readmission rates.[5,6]
[7] An important, but underemphasized, area of concern in home-based primary care is diagnostic error, including missed diagnosis, delayed diagnosis, and wrong diagnoses.[7]
[8] While this has been shown to be problematic in office-based primary care,[8-10] it has not been studied in home based primary care settings.
[9] While this has been shown to be problematic in office-based primary care,[8-10] it has not been studied in home based primary care settings.
[10] While this has been shown to be problematic in office-based primary care,[8-10] it has not been studied in home based primary care settings.
[11] Home-based care, as defined by the World Health Organization (WHO), is a series of services provided to people in their homes that may include physical, psychosocial, or palliative care activities.[11]
[12] These services may comprise 24-hour support or intermittent assistance for frail older adults, patients with disabilities, or those in need of prolonged post-hospitalization care.[12]
[13] Despite those challenges, some studies have shown that home-based care can provide patients an effective, safe, and appropriate continuation of medical services beyond the traditional care provided within hospital and clinic walls if evidence-based practices are followed.[13]
[14] In fact, a group of stakeholders has developed a three-category quality model (provider and practice activities; provider characteristics; and patient, provider, and caregiver outcomes) with 10 domains and 49 standards of care.[14]
[15] Custodial Care constitutes the largest segment of home-based care; it is estimated that more than 53 million (21.3%) Americans were informal caregivers to either a child or adult in 2020; over half of these provide care to 5.5 million adults, 3.6 million of whom have dementia.[15,16] Hospital care at home services provide health care to acutely ill patients in their homes by using methods that include telehealth, remote monitoring, and regular in-person visits by nurses.[15]
[16] Custodial Care constitutes the largest segment of home-based care; it is estimated that more than 53 million (21.3%) Americans were informal caregivers to either a child or adult in 2020; over half of these provide care to 5.5 million adults, 3.6 million of whom have dementia.[15,16]
[17] HHA services are defined as medical and personal care provided by professional nursing and rehabilitation staff and non-professional home health aides within the patient’s own place of living.[17 ]
[18] Referrals to an HHA are made solely at the discretion of a provider, resulting in substantial variability in referral practices that may result in some patients not receiving needed home health services.[18] Use of these standardized tools may support more standardized, efficient, and evidence-based referral processes and reduce the risk for adverse events.[18]
[19] In 2020, there were 11,221 HHAs, and almost 81% were for-profit.[19]
[20] For-profit HHAs have been reported to have higher costs ($4,827 compared with $4,075 per episode) and lower quality compared with not-for-profit agencies,[20]
[21] particularly pertaining to rehospitalization rates.[21]
[22] HHAs are nationally accredited by one of three accrediting bodies (The Joint Commission, Accreditation Commission for Health Care, or the Community Health Accreditation Program[22])
[23] and surveyed by the accrediting agency and the state agency approximately every three years.[23]
[24] One study of over 17 million hospitalizations comparing patient outcomes between patients discharged to skilled nursing homes versus home health found a higher 30-day readmission rate in patients discharged to home health, but at lower cost of care with no differences in functional outcomes or mortality.[24]
[25] Patients discharged from hospitals to HHA care have accounted for 25% of hospital readmissions associated with infections.[25,26]
[26] Patients discharged from hospitals to HHA care have accounted for 25% of hospital readmissions associated with infections.[25,26]
[27] For example, in a study of 28,205 home health care patients with urinary catheters, the lack of appropriate policies resulted in a 21% higher probability of hospital transfer due to urinary tract infections.[27]
[28] Another study found that HHAs that failed to provide required family caregiver training resulted in almost twice the number of acute care hospitalizations.[28]
[29] Similarly, an older study of hospital readmissions of patients after hip fracture, chronic obstructive pulmonary disease (COPD), pneumonia, stroke, and congestive heart failure (CHF), found that those patients were being readmitted at rates ranging from 12%-23% at 30 days and 18-34% at 60 days. These readmissions were associated with wide geographic variations in practice styles, local regulations, and availability of services.[29]
[30] A recent systematic review found that patients with heart failure had the highest rate of readmissions due to exacerbations of symptoms. However, other risk factors for readmission included older age, Black race, poor overall health status, severity of illness, more co-morbidities, living alone, fewer visits from home health aides, and other risks.[30]
[31] There have been several efforts to improve home health care, particularly focused on improving value, greater team-based care, more effective coordination of care across health care settings, and better focus on the use of technology and population health.[31]
[32] For example, for the past several years, CMS conducted a pilot Home Health Value-Based Purchasing (HHVBP) program and on January 1, 2022, began the Expanded HHVBP model.[32]
[33] A study targeted at patient safety and adverse events in home care of older persons with diabetes reported higher readmissions due to the patient’s reduced ability to self-care (associated with functional decline or cognitive impairment), suboptimal approach to care by home care agencies (failure to educate and train patients to care for themselves), and failure to conduct annual reviews to look for decline in patients’ conditions.[33]
[34] Studies have shown that higher registered nurse staffing and employing team-based approaches, including integrated practice in home care, have shown promise in improving patient outcomes.[34-37]
[35] Studies have shown that higher registered nurse staffing and employing team-based approaches, including integrated practice in home care, have shown promise in improving patient outcomes.[34-37]
[36] Studies have shown that higher registered nurse staffing and employing team-based approaches, including integrated practice in home care, have shown promise in improving patient outcomes.[34-37]
[37] Studies have shown that higher registered nurse staffing and employing team-based approaches, including integrated practice in home care, have shown promise in improving patient outcomes.[34-37]
[38] Home-Based Primary Care (HBPC) was originally designed for veterans who need team-based, in-home support for ongoing diseases and illnesses that affect their health and daily activities.[38]
[39] The modern-day “house call” delivers primary care only to the most medically complex homebound or home-limited patients, those who typically have difficulty attaining follow-up care, perpetuating the cycle of poor health management at high cost.[39]
[40] Portable x-ray and ultrasound equipment is readily available, and a smartphone can function as an electrocardiogram, an ultrasound console,[40]
[41] a portal to medical references (such as textbooks and drug databases[41]), and a means of transmitting paperwork (with remote scanning and printing capabilities[41]).
[42] a portal to medical references (such as textbooks and drug databases[41]), and a means of transmitting paperwork (with remote scanning and printing capabilities[42]).
[43] In recent years, an influx of nurse practitioners (NPs) has facilitated the growth of HBPC,[43,44]
[44] In recent years, an influx of nurse practitioners (NPs) has facilitated the growth of HBPC,[43,44]
[45] A systematic review conducted in 2016 examined HBPC of adults with serious illness and found that HBPC was associated with fewer hospitalizations and length of stay and that frail or sicker patients are more likely to benefit from HBPC services.[45]
[46] Independence at Home (IAH) is a specific type of home-based care service aimed at frail, homebound older adults that started as a CMS Innovation Center demonstration project.[46]
[47] As part of the IAH Demonstration, the CMS Innovation Center worked with select medical practices around the country to test the effectiveness of delivering comprehensive primary care services to Medicare beneficiaries with multiple chronic conditions in their homes.[47]
[48] The Commonwealth Fund report, “An Overview of Home-Based Primary Care: Learning from the Field,” identifies salient points and lessons learned from home-based primary care.[48] In Year 5, the payment incentive was associated with lower Medicare expenditures, but these results were driven by one site that soon thereafter stopped providing home-based primary care.[48]
[49] The most recent report available (2019) demonstrated only a $41 reduction per beneficiary per month in Year 6, which was not statistically significant.[49]
[50] HaH is designed to improve outcomes, decrease the length of stay, enhance patient experience, and reduce health care costs, which can be 19% to 30% less than for traditional inpatient care.[50]
[51] According to DeCherrie and colleagues, HaH has been associated with higher quality, improved patient safety, improved patient and family experience of care, and reduced cost in appropriately selected patients.[51]
[52] A 2018 case-controlled study of the HaH model with a control group of similar patients that did not select HaH services found that HaH patients had shorter length of stay, lower odds of hospital or ED readmission, and better patient experience of care.[52]
[53] However, other studies did not find lower readmission rates,[53]
[54] An older meta-analysis of 61 randomized control trials reported there was decreased mortality, lower readmission rates, and improved satisfaction of patients and caregivers[54] with the HaH program.
[55] Ongoing challenges to the program include lack of a regulatory framework, alterations in the electronic health record, and payment and billing mechanisms.[55,56] integrating a pharmacist[55,56]
[56] Ongoing challenges to the program include lack of a regulatory framework, alterations in the electronic health record, and payment and billing mechanisms.[55,56] integrating a pharmacist[55,56]
[57] The rising cost of healthcare, patient preferences, as well as the known risks associated with hospitalization (e.g., nosocomial infections, delirium, and other adverse events) have led to increasing demand for home-based care programs.
