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Surgical Innovation
April 28, 2021

Home Hospital for Surgery

Author Affiliations
  • 1Department of Surgery, University of Chicago, Chicago, Illinois
  • 2Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Harvard Medical School, Boston, Massachusetts
  • 5Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. Published online April 28, 2021. doi:10.1001/jamasurg.2021.0597

In November 2020, the US Centers for Medicare and Medicaid Services announced the Acute Hospital Care at Home waiver, an innovative payment and delivery system reform focused on the home hospital delivery model (HH). Home hospital delivers monitored at-home treatment that would otherwise require inpatient hospital admission.1 This care can include nursing and paramedic support, daily clinician and therapist visits, point-of-care laboratory and imaging tests, and administration of IV medications. There is evidence that HH is safer, cheaper, and more effective than traditional inpatient care, particularly for older adults. Home hospital programs have been established as beneficial for a wide range of conditions and are widely used in the United Kingdom, Spain, and Australia. Home hospital for surgery is an emerging option for perioperative care, with uses including preoperative monitoring, postoperative care, and even operation at home. Early efforts for general surgery have focused on ileostomy dysfunction.2 Routine postoperative care of patients undergoing orthopedic and bariatric surgery may be use cases for HH, and there is a burgeoning industry of private companies offering HH services. In the era of enhanced recovery after surgery (ERAS) and site-of-care optimization as a source of value in alternative payment models, HH is the next step in this progression toward patient-centered, value-based care. Home hospital also carries the potential to reduce surgical inequities by extending care to patients and geographic areas historically deprived of care.3

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