Goyal Anupama A, Berinstein Jeffrey A, Shrinivas Bishu, Higgins Peter D R, Taylor Stephanie
Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Case Rep Gastrointest Med. 2025 Aug 18;2025:4355773. doi: 10.1155/crgm/4355773. eCollection 2025.
The Centers for Medicare and Medicaid's Acute Hospital Care at Home waiver in 2020 has enabled the management of acute conditions that were traditionally cared for in the hospital to transition to the home setting. To our knowledge, data regarding the management of patients with acute severe ulcerative colitis (ASUC) in hospital at home (HaH) programs has not been reported. We conducted a retrospective review of ASUC patients admitted to our HaH program from our adult hospital, who demonstrated early clinical response but required a comprehensive, closely monitored treatment environment that was provided in the patients' homes. Patients received daily evaluations by hospitalists, gastroenterologists, and registered nurses with clinical assessments, monitoring of vitals, and therapeutics (e.g., intravenous fluids, corticosteroids, etc.), alongside daily blood monitoring for worsening inflammation. Patient demographics and UC disease characteristics were extracted from electronic health records. Outcomes of interest included emergency department (ED) visit, readmission, and mortality within 30 days of index admission; hospital-acquired conditions (HACs) of interest (delirium, catheter associated infections, and falls) during HaH stay; length of stay (LOS) in traditional hospital vs. HaH phase; and need for escalation back to traditional hospital. Three eligible and consenting ASUC patients were transferred to HaH. Two were female and one male, with a mean age of 59.7 years. The mean LOS in the traditional hospital was 8.7 days (range: 4-18), and 6 days (range: 4-9) in HaH. There were no escalations from HaH back to the traditional hospital. One patient had a 30-day ED visit (33%) with readmission (33%). There were no deaths within 30 days of index admission or documented HACs during HaH stay. Our case series highlights the preliminary feasibility of HaH for the management of ASUC patients, as a promising alternative to prolonged hospital-based care, without compromising patient safety or care quality.
2020年医疗保险和医疗补助服务中心的“急性病居家医院护理”豁免政策，使得传统上在医院治疗的急性病管理得以向家庭环境过渡。据我们所知，尚未有关于在家医院（HaH）项目中急性重症溃疡性结肠炎（ASUC）患者管理的数据报告。我们对从我院成人医院转入HaH项目的ASUC患者进行了回顾性研究，这些患者表现出早期临床反应，但需要在患者家中提供全面、密切监测的治疗环境。患者接受住院医师、胃肠病学家和注册护士的每日评估，包括临床评估、生命体征监测和治疗（如静脉输液、皮质类固醇等），同时每日进行血液监测以观察炎症是否恶化。从电子健康记录中提取患者人口统计学和UC疾病特征。感兴趣的结果包括首次入院后30天内的急诊科就诊、再入院和死亡率；HaH住院期间的感兴趣的医院获得性疾病（HACs）（谵妄、导管相关感染和跌倒）；传统医院与HaH阶段的住院时间（LOS）；以及升级转回传统医院的需求。三名符合条件并同意的ASUC患者被转入HaH。两名女性，一名男性，平均年龄59.7岁。传统医院的平均住院时间为8.
