Multi-Year Evaluation of VA San Diego’s Hospital in Home (HiH) Program

Abstract

Objective:

To assess the impact of the VA San Diego (VASD) Hospital in Home (HiH) program on clinical outcomes, health care utilization, costs, and patient experience.

Study Design:

Retrospective quality improvement analysis of all patients admitted to the VASD HiH program between October 2022 and March 2025.

Methods:

We evaluated 30-day heart failure (HF) readmission rates, inpatient bed-days in the 6 months before and after HiH admission, program costs, and patient satisfaction. Data were drawn from VASD’s Managerial Cost Accounting reports, the Corporate Data Warehouse, and post-discharge patient surveys.

Results:

The HiH program expanded from 25 to a projected 100 patients between 2021 and 2025. Average patient age was 74, with Care Assessment Needs (CAN) scores averaging 96. Readmission rates at 30 days were 16% for heart failure patients discharged to HiH compared to 17% for those discharged from VASD to home or facility. Heart failure patients admitted to HiH spent 41% fewer days inpatient in the 6 months after HiH admission compared to the 6 months before HiH admission. Cost per bed day was 89% lower on the HiH service compared to an inpatient bed-day, and total encounter cost was 35% lower. Patient satisfaction was universally positive, with 100% of surveyed Veterans recommending the program.

Conclusion:

VASD’s HiH program demonstrated that hospital-level of care delivered at home can safely reduce inpatient utilization, lower costs, and achieve high patient satisfaction within a VA setting.