Hospital-level care delivered at home for acutely ill adults

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

The investigators test a home hospital model that substitutes for inpatient acute care to avoid hospital-associated harms, long waits, and high costs. The home hospital team provides the typical inpatient components (physician, registered nurse, medications including IV therapy, monitoring, and use of modern medical technology) directly in the patient's home. Eligible adults must live within a roughly 5-mile or 20-minute driving radius of the participating emergency department, be able to consent (or have a proxy), and identify a caregiver for the first 24 hours of admission. Outcomes include quality and safety metrics, cost measures, and patient experience compared against usual hospital care, building on limited prior US demonstrations.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Resides within either a 5-mile or 20 minute driving radius of emergency department
* Has capacity to consent to study OR can assent to study and has proxy who can consent
* \>= 18 years-old
* Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
* Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.

Exclusion Criteria:

* Undomiciled
* No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
* On methadone requiring daily pickup of medication
* In police custody
* Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
* Domestic violence screen positive
* Acute delirium, as determined by the Confusion Assessment Method
* Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
* Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
* Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
* Cannot independently ambulate to bedside commode
* As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
* High risk for clinical deterioration
* Home hospital census is full (maximum 5 patients at any time)

Where it's running

• Brigham and Women's Hospital
  Boston, Massachusetts, United States Recruiting
• Brigham and Women's Faulkner Hospital
  Boston, Massachusetts, United States Recruiting

Study contacts

• Study coordinator: David M Levine, MD MPH MA
• Email: dmlevine@partners.org
• Phone: 617-732-7063

Similar studies

Other studies for the same condition or treatment. Recruiting studies are listed first.

• Research on health inequality and genetic disparity in cardiovascular diseases

  This study is trying to understand how health differences and genetics affect heart diseases in people from various ethnic backgrounds in the UK to help improve treatments for everyone.

  Recruiting Future Genetics Limited · Wolverhampton, West Midlands · NCT03987633

• Asthma and COPD among workers at Navanakorn Industrial Zone in Thailand

  This project will test how common asthma and COPD are among adult workers at the Navanakorn Industrial Zone by asking about breathing symptoms and doing lung function (spirometry) tests.

  Recruiting Thammasat University · Pathum Thani, Changwat Pathum Thani · NCT07383896

• Using oscillometry and FeNO to improve primary care diagnosis of asthma and COPD

  This study will test whether oscillometry and FeNO measurements help primary care doctors more accurately diagnose asthma and COPD in adults with suspected symptoms.

  Recruiting at 3 sites AstraZeneca · Buenos Aires and 11 other locations · NCT07245576

• Community- or home-based exercise for adults with weakened heart or lungs

  This test will see if an eight-week, community- or home-based exercise program can improve heart and lung function in adults 18–85 with reduced cardiopulmonary fitness.

  Recruiting Guangdong Provincial People's Hospital · Guangzhou, Guangdong · NCT07154355

• Using Apple Watch data to predict heart failure outcomes

  This study is testing if data from Apple Watches can help predict heart failure problems and the chances of needing to go back to the hospital for patients with heart failure.

  Recruiting University Medical Center Goettingen · Goettigen, Lower Saxony · NCT06819618

• Integrated care for older patients with atrial fibrillation

  This study is testing a new team-based care approach for older patients with atrial fibrillation and other health issues to see if it helps them manage their condition better than regular care.

  Recruiting at 50 sites Heart Care Foundation · Haskovo and 49 other locations · NCT06775028

How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.