Effect of hospital-at-home vs. traditional brick-and-mortar hospital care in acutely ill adults: study protocol for a pragmatic randomized controlled trial

Xiaoxi Yao, Margaret Paulson, Michael J Maniaci, Ajani N Dunn, Chad R Nelson, Emma M Behnken, Melissa S Hart, Lindsey R Sangaralingham, Shealeigh A Inselman, Michelle A Lampman, Shannon M Dunlay, Sean C Dowdy, Elizabeth B Habermann, Xiaoxi Yao, Margaret Paulson, Michael J Maniaci, Ajani N Dunn, Chad R Nelson, Emma M Behnken, Melissa S Hart, Lindsey R Sangaralingham, Shealeigh A Inselman, Michelle A Lampman, Shannon M Dunlay, Sean C Dowdy, Elizabeth B Habermann

Abstract

Background: Delivering acute hospital care to patients at home might reduce costs and improve patient experience. Mayo Clinic's Advanced Care at Home (ACH) program is a novel virtual hybrid model of "Hospital at Home." This pragmatic randomized controlled non-inferiority trial aims to compare two acute care delivery models: ACH vs. traditional brick-and-mortar hospital care in acutely ill patients.

Methods: We aim to enroll 360 acutely ill adult patients (≥18 years) who are admitted to three hospitals in Arizona, Florida, and Wisconsin, two of which are academic medical centers and one is a community-based practice. The eligibility criteria will follow what is used in routine practice determined by local clinical teams, including clinical stability, social stability, health insurance plans, and zip codes. Patients will be randomized 1:1 to ACH or traditional inpatient care, stratified by site. The primary outcome is a composite outcome of all-cause mortality and 30-day readmission. Secondary outcomes include individual outcomes in the composite endpoint, fall with injury, medication errors, emergency room visit, transfer to intensive care unit (ICU), cost, the number of days alive out of hospital, and patient-reported quality of life. A mixed-methods study will be conducted with patients, clinicians, and other staff to investigate their experience.

Discussion: The pragmatic trial will examine a novel virtual hybrid model for delivering high-acuity medical care at home. The findings will inform patient selection and future large-scale implementation.

Trial registration: ClinicalTrials.gov NCT05212077. Registered on 27 January 2022.

Keywords: Advanced care at home; Hospital at home; Inpatient; Pragmatic trial.

Conflict of interest statement

Mayo Clinic has a financial investment in Medically Home, the company that supports the ACH program. MJM serves on the Board of Directors for Medically Home, representing Mayo Clinic. At no point will any of the authors benefit financially from ACH. The other authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schedule of enrollment, interventions, and assessments
Fig. 2
Fig. 2
Evaluation of pragmatism—PRECIS-2 Wheel

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