Home hospital care recipients who receive remote physician visits have similar safety risks and self-reported patient experiences as their peers who receive in-person physician visits, according to a new study.
The findings were nuanced, however, Jeffrey L. Schnipper, MD, MPH, of Harvard Medical School, reported. There were a few more adverse events in the remote-care patient group, for example. And in a subset of remote-care patients, physicians opted to make at least one additional in-person visit to ensure proper care.
Schnipper and colleagues assessed 172 adult patients who had received acute-level care at home between August 2019 and March 2020. The range of acute conditions included infection, heart failure, chronic obstructive pulmonary disease and asthma.
Home hospital care included in-home nurse or paramedic visits, intravenous medications, remote monitoring and point-of-care testing. One group of patients received physician care remotely, including an initial home visit followed by daily video visits facilitated by a nurse. Another group received daily, in-home physician visits.
Notably, physicians assigned to the remote visits had an option to see their patients if they felt it was medically necessary.
Adverse events
Patients in each group rated their experiences similarly. And the number of adverse events, including falls, pressure injuries and delirium, were not significantly different than that of the in-person control group, the researchers reported. There were an estimated 2.8 more events per 100 patients in the remote-care group.
But for 19% of the remote-care patients, the ability to deliver in-home physician visits turned out to be a critical need, with physicians traveling to the home at least once beyond their initial visit, Schnipper and colleagues said. Additionally, remote care was associated with an increase of 8.5 minutes for nurse and paramedic visits.
The mean adjusted difference between the groups in 30-day hospital readmission rates was 2.28%, a result which the researchers deemed inconclusive.
There are clear trade-offs to the remote physician model, the authors wrote. Remote visits reduce travel burden and may allow a doctor to cover more patients, possibly expanding care rurally. But the additional time required for care coordination; and nurse and paramedic travel and visits — including facilitating the virtual care meetings —may counterbalance those benefits, they noted.
Regarding the study’s safety results, individual programs ultimately must decide “whether a potential increase in 2.8 adverse events per 100 patients is clinically meaningful to their program and patients,” the authors concluded in an article published in JAMA Network Open.
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