Outcomes of Hospital at Home for Older Adults with and without High Levels of Social Support.

Social support data were missing for many hospital-at-home patients, especially because the first hospital-at-home group did not receive the baseline survey; complete social support data were available for 86 hospital-at-home patients and 130 controls. Patients were not randomly assigned to hospital at home or in-hospital care; the control group included patients who declined hospital at home or presented outside admitting hours, so selection differences may remain. The researchers assumed missing social support data could be imputed at random, which may not be true if patients who did not receive the survey differed systematically. The study could not account for transitional services, including home visits, received by the in-hospital control group. The emergency department association was not statistically significant after adjustment for instrumental social support. Social support was self-reported and may be affected by reporting bias.

The evaluation was established through a Center for Medicare and Medicaid Innovation contract in 2014 and was initiated for internal program evaluation and reporting to the Centers for Medicare and Medicaid Services. The supplied text does not include a separate author conflict-of-interest declaration.

Do not read the favorable hospital-at-home associations as proof that social support is unnecessary for any home-based acute care. The program included physicians, physician assistants, nurse practitioners, registered nurses, social workers, physical therapists, occupational therapists and community paramedics, plus 24-hour access and 30 days of transitional services, so the study cannot separate the effect of any one component.