TOPLINE: 

Home hospital care in rural areas showed improved patient experiences and increased physical activity without a significant difference in cost compared with care at traditional hospitals.

METHODOLOGY: 

• Researchers conducted a randomized clinical trial (2022-2023) to evaluate the feasibility and efficacy of hospital-level care at home in rural settings.
• They enrolled 161 adult participants from rural areas at three sites in the US and Canada.
• Participants were recruited from emergency departments or medical wards and randomly assigned to receive either home hospital care (n = 79; mean age, 64.4 years) or traditional hospital care (n = 82; mean age, 64.9 years), with assessments conducted on admission, during discharge, and 30 days post-discharge.
• In-home care involved daily remote visits by physicians and in-person visits by nurses or paramedics, depending on the site's location; traditional hospital care services were delivered at rural brick-and-mortar hospitals.
• The primary outcome measured was the direct cost of the acute care episode, and the secondary outcomes included readmission rates at 30 days, days at home, patient experience scores, and levels of physical activity.

TAKEAWAY: 

• No significant difference in adjusted mean cost was found between home-hospital and traditional hospital care.
• Patients in the home hospital vs traditional hospital group had fewer daily blood tests (mean, 6.0 vs 9.2), whereas there was no significant difference between the groups in readmission rates (10.1% vs 17.1%).
• Safety events were similar between groups, with at least one safety event occurring in 14.1% of patients in the home hospital group and 12.4% of those in the traditional hospital group. Six patients in the home hospital group were transferred back to traditional hospitals due to nonadherence to protocol, worsening of symptoms, or falls.
• Patients in the home hospital group were more physically active than those in the traditional hospital group, spending less percentage of time per day sedentary (mean, 78.0% vs 86.0%) and walking more steps daily (mean, 834.1 vs 120.4). They also reported better experiences, with significant differences in mean experience (P < .001) and mean global satisfaction (P < .001) scores.

IN PRACTICE: 

"[I] t is important to place these results in context for patients and policymakers: to our knowledge, there are few interventions that improve patient experience and physical activity without requiring a higher cost," the authors wrote. "These data should inform the ongoing national and congressional dialogue for continued and one day permanent payment for hospital-level care at home," they added.

SOURCE: 

The study was led by David M. Levine, MD, MPH, of the Division of General Internal Medicine and Primary Care at the Brigham and Women's Hospital in Boston. It was published online on December 1, 2025, in JAMA Network Open.

LIMITATIONS: 

The study's generalizability is limited by its focus on three rural sites, with most participants being White and English-speaking. Data were gathered from patient reports and hospital electronic health records, which may not fully capture usage and costs.

DISCLOSURES: 

The study was funded by the Thompson Family Foundation. One author disclosed receiving personal fees from Biofourmis and Feminai outside the submitted work, and another author reported receiving in-kind research support from Brigham and Women's Hospital Ariadne Labs during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.