David Levine

When patient William Terry, MD, was randomly selected to participate in a pilot study to receive care at home instead of being admitted to BWH, he didn’t think twice about signing up.

“When it comes down to it, no one wants to be sick and in the hospital,” said Terry, an administrator in BWH’s Center for Interdisciplinary Cardiovascular Sciences. “If participating in the pilot meant that I could receive the same level of care that I would get in the hospital in the comfort of my own home, I was absolutely on board.”

For two months last year, David Levine, MD, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care, and co-principal investigator Jeff Schnipper, MD, MPH, piloted “The Home Hospital” project at BWH and BWFH. The pilot sought to compare the cost, quality, safety and experience of hospital-level care at home to traditional hospitalization. Levine received the Brigham Research Institute’s $100,000 BRIght Futures Prize for the project in 2016, which will enable him to expand the pilot this year and further study its outcomes.

Twenty-one adult patients participated in Levine’s randomized, controlled trial. The patients, who had to live within 5 miles of the Brigham in order to participate, sought treatment at the BWH or BWFH Emergency Department (ED) for infections, heart failure, asthma exacerbation or chronic obstructive pulmonary disease (COPD). The ED determined that they required admission, but before being admitted, eligible patients could enroll in the study and be randomly selected for either the home hospital or traditional inpatient admission.

The Home Hospital Model

At home, patients received visits from home hospital physicians Levine and Kei Ouchi, MD, MPH, and nurses Amy Costa, RN, Janet James, RN, Kathleen Melville, RN, and Peter Murphy, BSN, RN. All patients receiving care at home were given a tablet that allowed them to directly and confidentially communicate with their care team.

Once a patient’s health improved, he or she would be considered discharged from the Brigham – a judgment made using the same clinical criteria for discharging that BWH uses for inpatients. Research assistants Jeff Medoff, Apexa Patel and Natasha Thiagalingam were also part of the pilot.
While some procedures will always need to be performed in a hospital setting, there are cases where home may be the best place for patients to receive care and recover.

“We believe receiving care at home puts the patient first, improves patient experience and reduces costs,” Levine said. “For many conditions, a home hospital will transform our concept of safe, high-quality and cost-effective care.

Murphy, of Partners HealthCare at Home, said the pilot’s findings reinforced the fact that patients can still be supported by their care team from their own homes.

“When you’re at home with a patient, you are entirely focused on them in their own home environment,” Murphy said. “The whole person is right in front of you. You are able to help identify what they need in order for them to heal at home, while also encouraging them to be independent. I feel very fortunate that I was able to contribute to the advancement of this bright idea.”

Looking Down the Road

Levine plans to re-launch the project this spring. This time, they will accept a broader range of patients with different conditions and including other types of providers in the care teams. In addition, the project will be better integrated with Partners eCare.

“It has been an enormous privilege to work on this project with forward-thinking colleagues,” Levine said. “It impacts every part of the hospital and has allowed us to push the boundaries of how we care for patients.”