Characteristics Associated With Duration of Home Hospitalization in Internal Department Versus Hospitalization in the Hospital in Internal Ward

According to data from the OECD - Organization for Economic Co-operation and Development, the hospitalization crisis in Israel's hospitals is getting worse, both in relation to previous years in the State of Israel and in comparison to other countries [1]. There is an increase in life expectancy and the rate of aging of the population, which results in an increase in the number of beds in hospitals in relation to the growth rate of the population in need of treatment [2]. Furthermore, the government does not have the ability or an understandable plan for a significant and rapid increase in the number of hospital beds in the country. Instead, there is a recognition and a strategic decision by government officials in Israel, backed by the publication of relevant support tests [3], to develop hospitalization alternatives to hospital beds, primarily hospitalization within the community in the patient's natural environment, i.e. at home [4]. In a meta-analysis performed on patients with chronic diseases, it was found that the duration of treatment received by patients at home was 5.4 days longer compared to patients receiving treatment at the hospital, the risk of mortality was the same, re-hospitalization was lower among the patients hospitalized at home and the risk of worsening of the medical condition was smaller in 26 percent in hospitalization at home compared to hospitalization in the hospital [5]. For the patient receiving long-term care, it is extremely essential to be in a familiar and safe environment. Additional advantages to home hospitalization are a decrease in the chances of infection compared to the hospital and support from family members, both emotionally and physically [6].

Around the world, more and more experience is being accumulated in operating home hospitalizations as a substitute for hospitalization in a hospital. Comparative studies in diverse populations showed, already 20 years ago, that hospitalization at home is preferable to hospitalization in a hospital when it comes to the quality of life in a supportive and familiar environment [7]. However, the issue of the economic viability of home hospitalizations, whose cost was higher in the past, remains under question. There are studies that show a decrease in the cost of treatment in the home environment even in complex treatments and by professional teams [8]. Technological developments in the field of remote medicine have greatly contributed to improving the quality of care provided at home. Today, medical technology allows a patient who has been discharged from the hospital to be hospitalized at home, which allows the patient to continue to be treated at home through close medical and nursing supervision and advanced technological equipment. The technological development also allows cost reduction in different clinical settings such as: patients suffering from a flare-up of obstructive pulmonary disease [10,9], patients who are transferred to home hospitalization after surgery, elderly patients suffering from chronic diseases and needing hospitalization due to pneumonia and soft tissue infections, and patients suffering from exacerbation of heart failure [11]. The Ministry of Health and Welfare in the United States estimates that in 2030 one out of 5 Americans will be over the age of 65 and that home hospitalization is the preferred way to provide care to the patient as well as the optimal way in terms of costs [12]. This phenomenon will intensify the need for home hospitalization and will lead to improvements in the home sector [13].

At the Haim Sheba Tertiary Medical Center, they combine unique capabilities that make it particularly suitable for launching a home hospitalization service. The internal departments of the medical center are experienced in managing complex patients. The management of the departments is based on experts in internal medicine who have extensive experience in specializing in In the management of complex cases, with a high turnover of patients with mild and moderate degrees of severity, the hospital's position also matches the position of the relevant professional body - the Israeli Association of Internal Medicine - in regards to the launch of home hospitalization.

A center for innovation in digital health was established in Sheba, the purpose of which is to test and implement advanced technologies of remote medicine. Examining and operating these technologies, while having a unique collaboration with the companies that develop and manufacture them, places the innovation in an excellent opening position in terms of the ability to evaluate and operate the existing technologies in the hands of the doctors in the medical center.