Bruce Leff, MD, MACP: Discussing the ‘Hospital at Home’ Program for Older Adults

At the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Bruce Leff, MD, MACP, spoke with the HCPLive editorial team about his talk at the conference titled ‘Hospital at Home for Older Adults: Outcomes and Implementation.’

Leff, professor of medicine for the division of geriatric medicine at Johns Hopkins University School of Medicine, spoke on the Hospital at Home program and first discussed his inspiration for the talk given at ACP.

“I really got started to get interested in home-based medicine when I was a resident here at Johns Hopkins Bayview, where I was a primary care general medicine resident,” Leff explained. “In our second year of residency, the GIM residents picked up an extra clinic in addition to the hospital-based, house staff clinic, and mine was in our home-based primary care program. So this is a program developed by one of my mentors in the late 70s and it's a program that provides ongoing longitudinal primary care in patients homes when it's pretty much impossible for them to get to the clinic without a whole lot of work.”

Leff added that the program was designed essentially for homebound, older adults who tend to have multiple chronic conditions, functional impairment, and often lack social capital.

“I remember during that experience taking care of a patient who had a myocardial infarction at home, and I took care of several patients who had acute pneumonia, exacerbations of heart failure, or COPD,” Leff said. “They would often refuse to go to the hospital. We had to string together, in a very imperfect way, acute care at home. And it got us to think we could develop this into an actual real system of care, providing inpatient care in a person's home as a substitute for traditional hospital care, that was really the motivation.”

Leff noted that when such patients go to hospitals, it is often a very difficult environment for them and atherogenic complications, delirium, functional impairment, and other occurrences are often reported. He added that there has been a lot of data indicating that about a quarter of those who had been admitted to hospital suffered significant adverse events, strictly because of the hospital environment.

He was later asked about barriers to the program’s implementation covered in the presentation.

“The two (challenges) I would put at the top are leadership and, associated with that, payment,” Leff said. “You know, thinking about Hospital at Home, it is a countercultural type of model, and to do a lot of home and community based care, it's really not what health systems and hospitals are used to doing. It's not what they're wired to do.”

To learn more, view the full interview segment from ACP posted above.

The quotes contained here were edited for clarity. Leff has no relationships with entities whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.