When Carmen, an 84-year-old, was diagnosed with a respiratory infection requiring intravenous treatment, her family assumed that she would spend several days admitted to a hospital ward far from her familiar surroundings. That hospital bed never materialized: a medical team began visiting her daily at home, installed clinical monitoring systems, and organized her complete treatment without her having to leave the house.

Such cases are becoming increasingly common, highlighting the growing adoption of hospital-at-home (HAH) programs — a care model that delivers hospital-level treatment in the comfort of a patient’s home.

The expansion of this model raises the following key questions: Is it as safe as conventional hospitalization? Does it provide meaningful advantages, and where are its limitations? It also highlights the organizational changes required for broader implementation. Recent studies have begun to address these issues.

An increasing number of patients who previously needed an inpatient bed now receive treatment, advanced clinical monitoring, and daily medical follow-up at home. This shift is driven by rising healthcare demands and advances in telemedicine. HAH has emerged as one of the most significant changes in hospital care delivery.

DOMICON Data

The most comprehensive evaluation of this model comes from the Home Hospitalization Care Study for Patients With Complex Chronic Health Needs (DOMICON). This initiative, led by the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Hospital at Home (SEHAD), was conducted in late 2024 and included more than 2000 patients across 32 HAH units in 12 autonomous communities, representing the largest cohort assessed in Spain.

Preliminary findings presented at the 46th National Congress of the SEMI revealed a population with high clinical complexity. More than 68% of the participants had complex chronic conditions, with a mean age of 81 years. Approximately 70% were classified as frail, more than 50% required palliative care, and approximately 40% had a PROFUND index score of ≥ 11, associated with a 1-year mortality rate between 63% and 68%.

Most patients were referred from conventional hospital wards, particularly internal medicine, during acute exacerbations that could be managed at home with hospital-level support. These were not low-risk cases.

About 57% of patients were receiving more than 10 medications, indicating substantial clinical complexity.

The study found that patients treated at home had clinical complexity comparable to that in conventional wards when clear criteria and specialized teams ensured continuity of care. 

“This study has shown that patients receiving home-based hospital care are not so different from patients in conventional hospital settings. Until now, no scientific study of this kind had demonstrated that patients admitted to home care are as complex as patients in a conventional hospital ward,” emphasized Isabel Torrente Jiménez, an internist at the Parc Taulí University Hospital in Sabadell, Spain, and coordinator of the study. 

At the same time, variations in implementation across regions highlighted gaps in equity and healthcare planning.

Population Outcomes

Population-level data also provides insight into real-world outcomes. An analysis in Catalonia examined 31,901 cases of HAH, referring to care episodes designed to avoid hospital admission between 2015 and 2019, and compared them with conventional hospitalization using statistical adjustment methods. The cohort consisted largely of patients at a high or very high risk of multimorbidity.

In 2024, a study published in BMC Health Services Research reported an in-episode mortality rate of 0.32% and a 30-day mortality rate of 4.35%, both of which are comparable to those in conventional care. Thirty-day readmissions were 10.4%, and emergency department visits were 19.3%. These findings suggest a clinically safe model in the selected patients.

The authors noted substantial variation across center inclusion criteria, visit intensity, technological support, and 24-hour availability. They also noted the need for clearly defined quality indicators to establish HAH as a stable, structural part of the healthcare system, rather than as a temporary alternative during periods of healthcare pressure.

Oncology Expansion

Professionalization of this model is particularly evident in oncology. A joint consensus statement from the Spanish Society of Medical Oncology and SEHAD, published in Clinical and Translational Oncology in 2025, reported that 45 of the 48 HAH units surveyed in Spain routinely cared for patients with cancer. Care focused on infectious complications and palliative care. In addition, 19 units performed transfusions at home, and 13 units administered chemotherapy at home to carefully selected patients.

The document also confirmed cost-effectiveness across various conditions compared with conventional hospitalization and outlined clear selection criteria, including hemodynamic stability, adequate family support, and the ability to respond rapidly to complications, particularly in oncology settings. The authors concluded that in selected scenarios, HAH served as a safe extension of hospital care, even in complex cases.

Patient Experience

In addition to patient selection, HAH has evolved in its implementation, leading to hybrid care formats. One example is the La Casa de Sofía in Barcelona, established in 2022, which provides care for pediatric patients with complex chronic conditions or those receiving palliative care. This transitional home, linked to the hospital, offers specialized respiratory support and structured training for families, reduces prolonged hospital stays, and strengthens the continuity of care between the hospital and home.

In parallel, virtual wards integrated into the British National Health Service (NHS) are based on remote monitoring with daily follow-up. These models reported satisfaction rates above 95% with a clear preference for care at home. Patients reported greater comfort and autonomy, along with reduced exposure to infections. Evidence shows that rapid response systems and continuous hospital support are essential for achieving these outcomes. Overall, these approaches indicate that hospitalization is becoming less dependent on physical hospital settings and more centered on flexible care networks.

In palliative care, a 2025 review of patients with advanced cancer and dementia found that home-based care reduced hospital readmissions by 42%-91%, improved patient satisfaction and perceived safety, and increased the likelihood of dying at home. This finding aligns with the common preference for advanced disease. Although the results were consistent, differences in the study methods highlighted the need for more standardized research.

Cost Impact

Cost-effectiveness analyses showed that the cost per case in HAH was equal to or lower than that of conventional hospital admission, even in complex clinical settings. In models focused on admission avoidance or early discharge, reductions in acute care costs approached 50% without compromising clinical outcomes.

Data from the British NHS showed clear differences in the cost per day of care, with virtual beds costing significantly less than physical hospital beds. This combination of lower unit costs and shorter hospital stays generated estimated annual savings of millions of pounds, while also freeing thousands of beds and helping to reduce pressure on hospitals.

Furthermore, another analysis of healthcare systems under strain during and after the COVID pandemic, published in 2025, found that economic trends favored HAH. Its lower dependence on fixed infrastructure costs and flexibility to absorb peaks in demand without expanding hospital capacity make this model particularly relevant in the context of aging populations and increasing chronic disease.

Carmen’s case reflects a broader structural shift in healthcare. Her experience with HAH illustrated what accumulated evidence in recent years has shown. With appropriate patient selection, HAH provides outcomes comparable to conventional hospitalization in terms of safety and mortality, along with clear advantages in patient experience and efficiency.

However, the model is not suitable for all patients, and variations across programs require consistent criteria and rigorous evaluation of outcomes. HAH does not replace hospital admission but reframes it by balancing clinical safety, sustainability, and patient preference.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.