Risk factors associated with escalation of care in a quaternary academic hospital at home program.

ABSTRACT

BACKGROUND: Hospital-at-home has become a more recognized way to care for patients requiring inpatient hospitalization. At times, these patients may require escalation of care (transfer from home back to the brick-and-mortar (BAM) hospital for ongoing hospitalization care needs), a process that has not been extensively studied. OBJECTIVE: To evaluate what patient factors contribute to escalations of care in the hospital-at-home delivery model. DESIGNS, SETTINGS, AND PARTICIPANTS: We conducted a retrospective review of all patients admitted to Mayo Clinic's Advanced Care at Home (ACH) program from January 1, 2022 to December 31, 2022. INTERVENTION None. MAIN OUTCOMES AND MEASURES: Patient information was collected via electronic health record including demographic, socioeconomic, and clinical status. The primary outcome was the of occurrence of an escalation. RESULTS: A total of 904 patients were included, of whom 80 (8.8%) required an escalation of care. In multivariable analysis, risk of an escalation was significantly higher for patients who were married or had a life partner (HR 1.82, 95% CI 1.05-3.23, p = .033) for patients admitted with procedure-related disorders (HR 2.61, 95% CI 1.35-5.05, p = .005) and patients with an increased mortality risk score (HR [per each 1-category increase] = 1.86, 95% CI 1.39-2.50, p < .001).