EP538 - Admitting acute diverticulitis patients to home: Results from an established Hospital-at-Home Program

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Purpose/Background: Hospital-at-Home (HaH) has proven to be effective and safe for management of acute conditions requiring inpatient hospitalization, but outcomes for acute diverticulitis (AD) in this novel care setting remain unknown. Inpatient admission is standard for complicated diverticulitis and select uncomplicated cases. We have an established HaH program without face-to-face encounters by physicians, advanced practice providers, or acute care nurses,. This program provides 24-hour monitoring, labs, imaging, interventions, consultations, and hospital transfers. This study compares consecutive AD patients admitted to HaH to a prospectively screened cohort admitted to a brick-and-mortar hospital (BaM).

Methods/Interventions: We conducted a retrospective cross-sectional analysis using an IRB-approved HaH database across multiple tertiary care centers offering both BaM and HaH care options. Patients with complicated AD suitable for non-operative management or uncomplicated AD with indications for hospitalization such as severe comorbidities, persistent AD or intolerance to oral intake were assessed for HaH eligibility in the Emergency Department (ED) or medical wards via geographic, clinical, and psychosocial screening. We included all clinically eligible AD patients from 04/2023-08/2024, comparing HaH and BaM. Primary outcomes were HaH transfers to BaM, treatment escalations (urgent surgery or drainage), and 60-day hospital return rates (ED visits, readmissions and surgery) for unresolved AD. Secondary outcomes included length of stay, IV narcotics and fluids usage, and repeat imaging. Multivariable regression was used to model the odds of transfer, escalation, and hospital return.

Results/Outcomes: Over the study period, 99 patients with AD met inpatient admission criteria, with 60 (60.7%) admitted to HaH and 39 (39.3%) to BaM. Median age (69 vs. 72 years, p=0.372), gender (p=0.645), and white blood cell counts (10.4 vs. 10.8, p=0.7) were similar; however, HaH patients had a lower Charlson Comorbidity score (3 vs. 4, p=0.047). Fifteen HaH (25%) and 15 BaM (38.4%) patients had complicated AD (p=0.182), with similar modified Hinchey scores (p=0.136). Four HaH patients (6.6%) required transfer to BaM; 3 continued treatment, and 1 needed surgery. Overall, 3 patients escalated to urgent surgery (1.6% in HaH vs. 5.1% in BaM, OR: 0.31, 95%CI: 0.03-3.58, p=0.351). Thirteen patients returned to the hospital for unresolved diverticulitis within 60 days (8 [13.3%] HaH vs. 5 [13.8%] BaM, OR: 1.04, 95%CI: 0.32-3.47, p=0.941); including ED visits without readmission (5 [8.3%] HaH vs. 0 BaM, OR: 7.83, 95%CI: 0.42-145.69, p=0.168), readmissions without surgery (2 [3.3%] HaH vs. 3 [7.7%] BaM, OR: 0.41, 95%CI: 0.06-2.59, p=0.346), and readmissions with surgery (1 [1.6%] HaH vs. 2 [5.1%] BaM, OR: 0.31, 95%CI: 0.03-3.58, p=0.351). Index hospital stay was comparable (3 vs. 3 days, p=0.913). HaH patients had significantly lower use of IV narcotics (3.3% vs. 64%, OR: 0.02, 95%CI: 0.004-0.09, p< 0.001) and IV fluids (18.3% vs. 100%, OR: 0.004, 95%CI: 0.00002-0.06, p< 0.001), and fewer repeat CT scans (1.7% vs. 35.9%, p< 0.001, OR: 0.03, 95%CI: 0.004-0.25, p=0.001). Two patients opted for elective surgery post-resolution (1.6% HaH vs 2.6% BaM).

Conclusion/Discussion: The HaH care model appears to be a safe option for patients with AD requiring hospitalization, as shown by the absence of increased care escalation or hospital readmissions. Ongoing prospective evaluation of HaH will refine patient selection criteria and pathways for AD.