ORIGINAL RESEARCH article
Front. Digit. Health
Sec. Connected Health
Real-World Outcomes from 2,905 Episodes of Hospital at Home Care: A Propensity-Matched Cohort Study
Michael Shaw 1
Batool Almogheer 1
Dominique Auger 2
Andrew Barlow 1
Balasmita Bhaskaran 3
Maria Buxton 4
Marco Cerulli 1
Kalpana Giri Ghimire 1
Edward Hiller 1
Zoe Jayne 1
Michal Kelly 5
Matthew Knight 1
Eleanor Zinkin 1
Niall Keenan 1,6
1. West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
2. Imperial College Healthcare NHS Trust, London, United Kingdom
3. West Hertfordshire Teaching Hospitals NHS Trust, Watford, United Kingdom
4. Central London Community Healthcare NHS Trust, London, United Kingdom
5. East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
6. Imperial College London, London, United Kingdom
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Abstract
Background: Hospital at home (HAH) services within the UK have expanded rapidly over the last five years, but there is comparatively little evidence demonstrating their clinical eEectiveness. We evaluated clinical outcomes, safety, and cost-eEectiveness of a comprehensive HAH service in England. Methods: We conducted a retrospective cohort study of patients admitted to our HAH service between December 2021 and May 2024, including pathways for heart function (HF), airways disease (ABC), and acute respiratory infection (ARI). A 1:1 propensity score matched control cohort of patients admitted to inpatient care was created, using regression adjustment to derive doubly robust estimates of main outcomes. Primary outcomes included length of stay and total bed-day costs. Secondary outcomes included 30-day readmission rates, 90-day mortality, and patient experience and acceptability metrics. Results: We analysed 2,972 HAH episodes, yielding after exclusions a total of 1,488 inpatient-originated (IP) episodes which were matched 1:1 to controls, as well as 754 admission prevention episodes (AP) for separate analysis. HAH reduced length of stay compared to matched inpatient controls (bed-day savings: 3.13 days, 95% CI 2.60–3.67, p<1x10-29). Total bed-day savings were 13,119 days, yielding net savings of £3.79 million over 33 months. All-cause 30-day readmission rates were significantly lower in HAH cohorts compared to matched controls (OR 0.55, 95% CI 0.42–0.70, p<3x10-6), as was total time in hospital over 90 days from initial presentation (2.64 days fewer, 95% CI 1.87 - 3.40, p<2x10-11) and 90-day all-cause mortality (OR 0.43, 95% CI 0.35–0.53, p<3x10-16). Conclusions: This large real-world evaluation demonstrates that HAH services significantly reduce both length of stay, readmissions and healthcare costs while maintaining safety and possibly reducing mortality. These findings support wider implementation of HAH.
Summary
Keywords
Cost Effectiveness, Hospital at Home, Length of Stay, Virtual Hospital, Virtual ward
Received
30 September 2025
Accepted
17 February 2026
Copyright
© 2026 Shaw, Almogheer, Auger, Barlow, Bhaskaran, Buxton, Cerulli, Giri Ghimire, Hiller, Jayne, Kelly, Knight, Zinkin and Keenan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Michael Shaw
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