Comprehensive geriatric hospital-at-home increases the days at home in older adults compared to bed-based intermediate care: a propensity score matching analysis

Abstract

Objectives: To compare the effectiveness and safety of Hospital-at-Home based on Comprehensive Geriatric Assessment (CGA-HaH) for older adults with bed-based Intermediate Care Unit (BBU).Design: Cohort study comparing all consecutive CGA-HaH cases managed between January 2018 and December 2023 with contemporary BBU-matched controls at the largest geriatric care provider in Barcelona.Methods: We linked all intermediate care admissions at Parc Sanitari Pere Virgili to the Catalan health information system data to track patients' trajectories from 6 months before the index episode to June 2024. Patients admitted to CGA-HaH were matched to BBU controls using propensity score matching (PSM) based on their baseline characteristics. We used multivariable linear regression to assess the association of CGA-HaH with the percentage of days spent at home (%DSH) and Cox regression to assess the risk of death and first re-hospitalisation.Results: We included 1180 consecutive CGA-HaH and 10,528 BBU episodes. CGA-HaH patients were significantly older and more functionally impaired and had better socioeconomic status. After PSM, we compared 961 CGA-HaH and 961 BBU patients, with a mean follow-up of 705 days (SD 593). CGA-HaH patients had a 7.4 higher %DSH (95% CI: 4.5-10.2, P < 0.001) with similar first re-hospitalisation [HR 1.02 (95% CI: 0.91-1.1)] and mortality risk [HR: 0.93 (95% CI: 0.81-1.06)].Conclusions: Our results suggest that CGA-Hospital-at-Home is a viable alternative to traditional inpatient intermediate care for older adults, offering relevant advantages such as increased time spent at home without a rise in mortality.