Emergency Care at Home for Urgent Medical Needs

Overseen By David Levine, MD, MPH, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Brigham and Women's Hospital

Disqualifiers: Substance use, Psychiatric concerns, Home safety, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: Up to 9 days

1500 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will assess the efficacy of receiving emergency care at home versus in the brick-and-mortar emergency department.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Emergency Care at Home for Urgent Medical Needs is an effective treatment?

The available research shows that Emergency Care at Home can be as effective as traditional hospital care. For example, a study comparing hospital at home care with inpatient hospital care found similar patient outcomes after three months. Another study highlighted that early discharge hospital at home services provide necessary treatments at home that would otherwise require hospital stays. Additionally, home hospitalization directly from the emergency department was found to be an efficient alternative to standard inpatient care, with comparable patient satisfaction and health outcomes. These findings suggest that Emergency Care at Home can be a viable and effective alternative to traditional hospital care for urgent medical needs. ^{1 2 3 4 5}

What safety data exists for Emergency Care at Home?

The provided research does not directly address safety data for Emergency Care at Home or its variants. However, it highlights issues related to emergency care service use, such as the decision-making process for seeking emergency care and the role of telemedicine in prehospital emergencies. These studies suggest a need for further research specifically focused on the safety and effectiveness of in-home urgent care services. ^{4 6 7 8 9}

Is Emergency Care at Home a promising treatment for urgent medical needs?

Yes, Emergency Care at Home is a promising treatment because it allows patients to receive urgent medical attention in the comfort of their own homes. This can reduce unnecessary hospital visits, provide timely care, and ensure that patients are treated efficiently and respectfully by a team of healthcare professionals. It also helps in managing emergency situations effectively by coordinating with emergency services when needed. ^{4 6 10 11 12}

Eligibility Criteria

Adults over 18 living in permanent housing within the Home Hospital area, who intend to visit the emergency department and are patients of a Mass General Brigham primary care provider. Excluded are those with workers' comp or motor vehicle accident insurance, living in healthcare facilities, with substance use or acute psychiatric issues, needing inpatient care or therapies, at high risk (e.g., very high heart rate or low blood pressure), or requiring certain exams and monitoring not available at home.

Inclusion Criteria

Resides within Home Hospital geographic area

Lives in permanent housing (i.e., not in temporary housing such as a shelter)

I plan to visit the emergency department.

Exclusion Criteria

Insurance: workers compensation and motor vehicle accident

Lives in a healthcare facility (Skilled Nursing, Rehab, long term acute care)

I or my caregiver cannot respond to the door or phone.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive emergency care either at home or in the emergency department

Up to 9 days

Emergency care visit

Follow-up

Participants are monitored for emergency department presentation, observation, or hospitalization

9 days

Treatment Details

Interventions

• Emergency Care at Home

Trial Overview The study compares the effectiveness of emergency care provided at home with traditional emergency department care. Participants will either receive emergency treatment in their own living space or at a physical emergency department location to determine which is more effective.

Participant Groups

Group I: Emergency care at home Experimental Treatment 1 Intervention

Emergency care in the patient's home.

Group II: Usual care Active Control 1 Intervention

Emergency care in a brick-and-mortar emergency department.

Emergency Care at Home is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Emergency Care at Home for:

• Acute care needs
• Urgent medical conditions
• Post-hospital care

Approved in European Union as In-Home Urgent Care for:

• Emergency medical conditions
• Acute illnesses
• Injury care

Approved in Canada as Hospital-at-Home Care for:

• Acute medical conditions
• Post-surgical care
• Chronic condition management

Who Is Running the Clinical Trial?

Brigham and Women's Hospital

Lead Sponsor

Trials

1,694

Recruited

14,790,000+

Findings from Research

Patients recovering from hip replacement surgery experienced a significant improvement in quality of life when receiving hospital at home care compared to traditional inpatient care, indicating its efficacy for this specific group.

Overall, there were no major differences in outcomes between hospital at home and inpatient care for most patient groups, suggesting that while hospital at home may be preferred by many, its cost-effectiveness needs to be carefully considered.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. Shepperd, S., Harwood, D., Jenkinson, C., et al.[2022]

In a study of 75 emergency home visits to nursing home patients, physicians rated the urgency of visits lower (average score of 5.7) compared to nurses (average score of 7.2), indicating a disagreement in urgency assessment.

The findings suggest that without standardized criteria for classifying emergency visits, many home visits may be misclassified, highlighting the need for a uniform assessment system to improve the efficiency of emergency care for nursing home patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Urgency of GP Emergency Visits to Nursing Homes]. Bleckwenn, M., Ahrens, S., Schnakenberg, R., et al.[2018]

Early discharge hospital at home services likely do not significantly affect mortality rates or hospital readmission risks compared to traditional inpatient care, based on a systematic review of 32 trials involving 4746 participants.

However, these services may reduce hospital length of stay by about seven days and potentially lower the risk of patients living in institutional settings, while also slightly improving patient satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early discharge hospital at home. Gonçalves-Bradley, DC., Iliffe, S., Doll, HA., et al.[2022]

In a pilot study involving 31 Medicare patients, most individuals (57.1%) contacted their primary care physicians before seeking emergency care, indicating a reliance on professional advice prior to emergency visits.

The study found that both primary care physicians and home health care providers often advised patients to seek emergency care, suggesting that there may be a perception that emergency services are necessary, although the appropriateness of this advice was not assessed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary assessment of appropriateness of emergency care service use: actions taken and consultations obtained before emergency care presentation. Tzeng, HM.[2018]

Patients admitted to hospital at home (HAH) from the emergency department (ED) had a significantly shorter length of stay (1.02 days) compared to those admitted through standard hospitalization (SH) (2.23 days), indicating a potential efficiency advantage of HAH.

No significant differences were found in patient demographics, clinical aspects, health status, or quality of care between the HAH and SH groups, suggesting that HAH can provide comparable care while reducing hospital stay duration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Home hospitalization directly from emergency department: an efficient alternative to standard inpatient hospitalization]. Jiménez, S., Aguiló, S., Antolín, A., et al.[2019]

A nationwide survey of 708 Germans revealed that many people misjudge the urgency of medical situations, with misjudgment rates of 20% for high urgency, 50% for medium urgency, and 27% for low urgency cases.

One in four participants would incorrectly choose not to call an ambulance for critical conditions like stroke or heart attack, highlighting a need for improved health literacy and possibly a unified emergency contact system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Emergency medical service, medical on-call service, or emergency department : Germans unsure whom to contact in acute medical events]. Metelmann, B., Brinkrolf, P., Kliche, M., et al.[2023]

In a study involving 3531 patients, the tele-emergency medical service was found to be non-inferior to conventional physician-based emergency services, with only one adverse event occurring in the tele-emergency group, indicating its safety in severe emergencies.

The tele-emergency service was utilized in a significantly higher percentage of cases (57.8%) compared to the conventional service (6.4%), suggesting it can effectively manage many emergencies without the need for a physical physician on-site.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial. Kowark, A., Felzen, M., Ziemann, S., et al.[2023]

A study involving 27 healthcare practitioners revealed that the NHS 111 First system, designed to triage patients before entering the emergency department (ED), faced challenges due to existing local triage systems that created bottlenecks, leading to frustration among staff and patients.

Participants expressed concerns about the effectiveness of remote algorithm-based assessments compared to in-person evaluations, suggesting that reliance on clinical expertise is crucial for accurate patient triage and may hinder the full potential of the 111 First system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Emergency department staff views of NHS 111 First: qualitative interview study in England. MacLellan, J., Turnbull, J., Prichard, J., et al.[2023]

A new emergency room model in Aust-Agder, Norway, which reduced house calls and required patients to visit the emergency room, did not lead to dissatisfaction among patients, indicating that larger off-hour primary care services can be implemented without negatively impacting patient experience.

The reorganization resulted in a 31% cost saving for the social security service regarding on-call doctors, although municipalities experienced a 17% increase in expenses, suggesting a mixed financial impact on the overall healthcare system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Emergency service in Arendal--a new model of intermunicipal emergency service]. Werner, EL.[2015]

In a study of the Vienna emergency doctor's service, the most common reasons for initiating an urgent home visit were angina, bronchial asthma, and dyspnoea, indicating these conditions are prioritized due to their potential severity.

The decision for an urgent visit is primarily based on the diagnosis related to dangerous diseases rather than just the symptoms alone, highlighting the importance of clinical judgment in emergency situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[What leads to urgent house calls at an emergency medical service?]. Tönies, H.[2018]

Private practice professionals providing home care often work in isolation but are supported by a multidisciplinary care network for effective patient management.

In life-threatening emergencies, the Aide Médicale Urgente control center can quickly activate emergency services, ensuring efficient and respectful patient transfer to hospitals through accurate assessment and regulatory knowledge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Private practice nursing, reacting in emergency situations. Private practice nursing, reacting in emergency situations]. Royère, C., Allonneau, A., Genotelle, N., et al.[2017]

In a study of 94 patients seeking care for chronic or sub-acute problems in episodic care settings, 20% reported that their work probably caused their illness, while 15% indicated their illness was worsened by work, highlighting the prevalence of occupational health concerns in these environments.

Despite the significant number of patients experiencing work-related health issues, discussions about workplace factors occurred in only 21% of physician-patient encounters, suggesting a need for better integration of occupational health assessments in episodic care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occupational issues in episodic care populations. Harber, P., Bublik, M., Steimberg, C., et al.[2007]

References

1. England pubmed.ncbi.nlm.nih.gov

Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. [2022]

2. Germany pubmed.ncbi.nlm.nih.gov

[Urgency of GP Emergency Visits to Nursing Homes]. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Early discharge hospital at home. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Preliminary assessment of appropriateness of emergency care service use: actions taken and consultations obtained before emergency care presentation. [2018]

5. Spain pubmed.ncbi.nlm.nih.gov

[Home hospitalization directly from emergency department: an efficient alternative to standard inpatient hospitalization]. [2019]

6. Germany pubmed.ncbi.nlm.nih.gov

[Emergency medical service, medical on-call service, or emergency department : Germans unsure whom to contact in acute medical events]. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Emergency department staff views of NHS 111 First: qualitative interview study in England. [2023]

9. Norway pubmed.ncbi.nlm.nih.gov

[Emergency service in Arendal--a new model of intermunicipal emergency service]. [2015]

10. Austria pubmed.ncbi.nlm.nih.gov

[What leads to urgent house calls at an emergency medical service?]. [2018]

11. France pubmed.ncbi.nlm.nih.gov

[Private practice nursing, reacting in emergency situations. Private practice nursing, reacting in emergency situations]. [2017]

12. United States pubmed.ncbi.nlm.nih.gov

Occupational issues in episodic care populations. [2007]