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Alternative strategies to inpatient care offer lower costs, comparable outcomes

A variety of acute medical conditions typically overseen in a hospital inpatient setting can be managed at lower costs through alternative outpatient strategies that yield similar clinical outcomes and patient satisfaction, according to data published in JAMA Internal Medicine.

“The U.S. health care system is in the midst of transformation as it seeks to improve the health outcomes of populations and individual patients at an affordable cost,” Jared Conley, MD, PhD, MPH, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “One important area of redesign is identifying the best management setting for the diagnosis and/or treatment of acute medical conditions... [Innovative care delivery models] suggest that safe, alternative management strategies exist that obviate the need for inpatient admission.”

Conley and colleagues evaluated systematic reviews that assessed alternative management strategies to inpatient care. The researchers analyzed study data including trial design, eligibility criteria, clinical outcomes, patient experience and health care costs data to evaluate the efficacy, safety and cost of managing acute medical conditions in alternative settings to hospitalization. They used the revised AMSTAR tool and the Oxford Centre for Evidence-Based Medicine to grade the quality of each review and the strength of evidence from each study, respectively.

The analysis included 25 systematic reviews representing 123 primary studies conducted between January 1995 and February 2016. There was no significant difference in mortality, disease-specific outcomes or patient satisfaction for a variety of acute medical conditions treated with outpatient management strategies compared with those who were hospitalized in an inpatient unit.

Limited evidence indicated that patients treated in quick diagnosis units had low mortality rates and high patient satisfaction. Hospital-at-home treatment resulted in improved or stable mortality rates, disease-specific outcomes, and patient and caregiver satisfaction for several acute medical conditions compared with hospital admission. Differences in mortality, a decreased length of stay and improved patient satisfaction were not found for observation units in comparison to hospital inpatient units. Some conditions generated more limited results.

Overall, cost data varied; however, all alternative management strategies produced widespread savings.

“Our findings of alternative management strategies for low-risk patients with acute medical conditions conventionally treated via hospitalization suggest that safe and effective care can be achieved in lower cost settings with positive or neutral impact on patient satisfaction,” Conley and colleagues concluded. “Further examination with [randomized controlled trials] and high-quality comparative observational studies for some conditions and models of care is warranted.” – by Alaina Tedesco

Disclosure: The researchers report funding by the Stanford University, the Levy Foundation and a VA Health Services Research and Development Service career development award.