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

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).