Background Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with COVID-19. Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organised by a team of local primary care clinics. Methods We conducted a multi-center retrospective cohort study of the COVID-19 patients who received our HaH care from Jan 1st to Mar 31st, 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka City were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. Results Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only one home visit in addition to online treatment. Conclusions The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.

The authors have declared no competing interest.

https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000054537

The study was funded by the grants from Osaka Prefecture and Nippon Foundation. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect the funding source.

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The study was approved by the Ethics Committee of Japan Primary Care Association (ethics approval number: R2628).

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