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An advanced medical care at home (AMCAH) program produced no differences in readmission, mortality, or guideline-directed medical therapy (GDMT) utilization compared with continued brick-and-mortar (BAM) hospitalization for acute heart failure (HF), according to a retrospective cohort study by Cheng-Wei Huang, MD, and colleagues published July 16 in JAMA Network Open. The analysis covered 11 service areas within Kaiser Permanente Southern California and included patients hospitalized with a principal diagnosis of HF between February 2023 and December 2024.
After propensity score matching, the intra-service-area comparison yielded 307 pairs, with a mean age of 75 years. At 30 days, the composite of all-cause escalation, readmission, or mortality occurred in 73 AMCAH patients (24%), including 18 escalations (6%), compared with 80 BAM patients (26%), for an odds ratio of 0.89 (95% CI, 0.61 to 1.28). Days alive and out of the hospital were 28.2 and 28.3, respectively. The mean GDMT score was 3.2 versus 3.1 on a 0-to-9 scale. A separate inter-service area comparison of 239 pairs was consistent, and no differences emerged at 60 days in either analysis.
The program is not a telehealth check-in. It includes mobile phlebotomy, intravenous medication administration, nursing visits, remote patient monitoring, virtual case management, and daily virtual physician rounding. Index hospitalization was about a day shorter in the AMCAH group (3.5 days versus 4.5 days), followed by a mean of 4.7 days at home.
The authors then emphasize that eligibility was determined on a case-by-case basis by AMCAH physicians, and further that their findings should be interpreted as supporting the safety of clinician judgment in patient selection, rather than as evidence of intrinsic equivalence between AMCAH and inpatient care. Program penetration reached only 6%-7%.
The study intentionally sidesteps the money question. The authors state it was not designed to assess cost and that the length-of-stay figures should not be read in isolation. They also note that Kaiser's integrated structure and value-based approach, with no encounter-level incentives, both strengthen the comparison and limit how far it travels, and that findings from their system may not be immediately applicable to others.
The authors conclude that the results support further scaling and adoption of AMCAH.
