"Hospital-at-home and 30-day readmission among clinically eligible patients: a prospective cohort study with a capacity-constrained comparator group".

BACKGROUND AND AIMS: To evaluate the association between hospital-at-home (HaH) care and unplanned 30-day hospital readmission using a capacity-based comparator group of clinically eligible patients admitted to conventional hospitalization (CH) because of lack of HaH capacity. METHODS: This prospective observational study was conducted between 2023 and 2026 at a tertiary hospital in Spain. A total of 890 episodes were included: 718 in HaH and 172 in CH. The primary outcome was 30-day readmission. Propensity score matching and multivariable logistic regression were used to control for confounding. RESULTS: Complete readmission data were available for 879 episodes. The 30-day readmission rate was lower in the HaH group both in the unadjusted analysis (12.08% vs 19.76%; p = 0.009) and after propensity score adjustment (12.08% vs 20.79%; an average treatment effect on the treated (ATT) -0.087; 95% CI -0.168 to -0.006; p = 0.034). Multivariable analysis confirmed an independent association between HaH care and lower readmission risk (OR 0.61; 95% CI 0.38-0.95; p = 0.031). Frailty was independently associated with readmission risk. No significant differences were observed in adjusted mortality. CONCLUSIONS: Among clinically eligible patients, HaH care was associated with a clinically relevant reduction in 30-day hospital readmission, without evidence of increased mortality or safety concerns.