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Abstract：
BACKGROUND: There is no widely accepted care model for managing high-need, high-cost (HNHC) patients. We hypothesized that a Home Heart Hospital (H3), which provides longitudinal, hospital-level at-home care, would improve care quality and reduce costs for HNHC patients with cardiovascular disease (CVD).
OBJECTIVE: To evaluate associations between enrollment in H3, which provides longitudinal, hospital-level at-home care, care quality, and costs for HNHC patients with CVD.
METHODS: This retrospective within-subject cohort study used insurance claims and electronic health records data to evaluate unadjusted and adjusted annualized hospitalization rates, total costs of care, part A costs, and mortality rates before, during, and following H3.
RESULTS: Ninety-four patients were enrolled in H3 between February 2019 and October 2021. Patients\' mean age was 75 years and 50% were female. Common comorbidities included congestive heart failure (50%), atrial fibrillation (37%), coronary artery disease (44%). Relative to pre-enrollment, enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction (AR): 2.4 hospitalizations/year, 95% confidence interval [95% CI]: -0.8, -4.0; p < 0.001; total costs of care (AR: -$56 990, 95% CI: -$105 170, -$8810; p < 0.05; and part A costs (AR: -$78 210, 95% CI: -$114 770, -$41 640; p < 0.001). Annualized post-H3 total costs and part A costs were significantly lower than pre-enrollment costs (total costs of care: -$113 510, 95% CI: -$151 340, -$65 320; p < 0.001; part A costs: -$84 480, 95% CI: -$121 040, -$47 920; p < 0.001).
CONCLUSIONS: Longitudinal home-based care models hold promise for improving quality and reducing healthcare spending for HNHC patients with CVD.
OBJECTIVE: To evaluate associations between enrollment in H3, which provides longitudinal, hospital-level at-home care, care quality, and costs for HNHC patients with CVD.
METHODS: This retrospective within-subject cohort study used insurance claims and electronic health records data to evaluate unadjusted and adjusted annualized hospitalization rates, total costs of care, part A costs, and mortality rates before, during, and following H3.
RESULTS: Ninety-four patients were enrolled in H3 between February 2019 and October 2021. Patients\' mean age was 75 years and 50% were female. Common comorbidities included congestive heart failure (50%), atrial fibrillation (37%), coronary artery disease (44%). Relative to pre-enrollment, enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction (AR): 2.4 hospitalizations/year, 95% confidence interval [95% CI]: -0.8, -4.0; p < 0.001; total costs of care (AR: -$56 990, 95% CI: -$105 170, -$8810; p < 0.05; and part A costs (AR: -$78 210, 95% CI: -$114 770, -$41 640; p < 0.001). Annualized post-H3 total costs and part A costs were significantly lower than pre-enrollment costs (total costs of care: -$113 510, 95% CI: -$151 340, -$65 320; p < 0.001; part A costs: -$84 480, 95% CI: -$121 040, -$47 920; p < 0.001).
CONCLUSIONS: Longitudinal home-based care models hold promise for improving quality and reducing healthcare spending for HNHC patients with CVD.
摘要：
背景：没有广泛接受的管理高需求的护理模式，高成本（HNHC）患者。我们假设家庭心脏医院(H3)，它提供了纵向，医院一级的家庭护理，将提高HNHC心血管疾病（CVD）患者的护理质量并降低成本。
目的：为了评估H3注册之间的关联，医院一级的家庭护理，护理质量，和HNHC患者CVD的费用。
方法：这项回顾性研究使用保险索赔和电子健康记录数据来评估未经调整和调整的年度住院率，护理总费用，A部分费用,和之前的死亡率，during,跟随H3。
结果：在2019年2月至2021年10月期间，94名患者在H3中入选。患者平均年龄为75岁，50%为女性。常见的合并症包括充血性心力衰竭（50%），心房颤动（37%），冠状动脉疾病（44%）。相对于预注册，H3的入组与年住院率显着降低相关（绝对减少（AR）：2.4住院/年，95％置信区间[95％CI]：-0.8，-4.0；p<0.001；护理总费用（AR：-$56990，95％CI：-$105170，-$8810；p<0.05；A部分费用（AR：-$78210，95％CI：-$114770，-$41640；p<0.001）。H3后的年度总成本和A部分成本显着低于入学前成本（护理总成本：-113510美元，95％CI：-151340美元，-65320美元；p<0.001；A部分成本：-84480美元，95％CI：-121040美元，-47920美元；p<0.001）。
结论：纵向家庭护理模式有望改善HNHC伴CVD患者的质量并减少医疗支出。
目的：为了评估H3注册之间的关联，医院一级的家庭护理，护理质量，和HNHC患者CVD的费用。
方法：这项回顾性研究使用保险索赔和电子健康记录数据来评估未经调整和调整的年度住院率，护理总费用，A部分费用,和之前的死亡率，during,跟随H3。
结果：在2019年2月至2021年10月期间，94名患者在H3中入选。患者平均年龄为75岁，50%为女性。常见的合并症包括充血性心力衰竭（50%），心房颤动（37%），冠状动脉疾病（44%）。相对于预注册，H3的入组与年住院率显着降低相关（绝对减少（AR）：2.4住院/年，95％置信区间[95％CI]：-0.8，-4.0；p<0.001；护理总费用（AR：-$56990，95％CI：-$105170，-$8810；p<0.05；A部分费用（AR：-$78210，95％CI：-$114770，-$41640；p<0.001）。H3后的年度总成本和A部分成本显着低于入学前成本（护理总成本：-113510美元，95％CI：-151340美元，-65320美元；p<0.001；A部分成本：-84480美元，95％CI：-121040美元，-47920美元；p<0.001）。
结论：纵向家庭护理模式有望改善HNHC伴CVD患者的质量并减少医疗支出。
