A hybrid hospital-at-home model leads to greater early physical activity and higher patient satisfaction than conventional inpatient care, without evidence of increased harm, according to a randomised clinical trial, although it was not powered to detect differences in safety outcomes.

Danish researchers evaluated whether a telemedicine-supported hybrid hospital-at-home programme could improve mobility and patient experience among adults admitted with acute medical conditions compared with standard inpatient, brick-and-mortar care.

The investigator-initiated trial, published in the journal JAMA Network Open, was conducted at two internal medicine wards at Nordsjaellands Hospital between June 2023 and January 2025.

The single centre, non-blinded randomised clinical trial enrolled 111 adults admitted with acute illness. Participants were randomised 1:1 to either the hybrid hospital-at-home pathway (n=58) or conventional inpatient brick-and-mortar care (n=53).

The median age was 64 years in the hospital-at-home group and 65 years in the brick-and-mortar group, and approximately half of participants in each arm were male. Most patients were recruited from pulmonary and infectious diseases services, and many admissions were infection-related, including pneumonia, bacteraemia and urinary tract infections.

The hospital-at-home intervention combined remote patient monitoring, virtual physician ward rounds and home-based clinical care delivered by hospital or community nurses. Patients were monitored continuously through a telemedicine platform with 24/7 clinical oversight.

Hospital-at-home care and physical activity

The primary outcome analysis showed that patients assigned to hospital-at-home were significantly more physically active during the first 24 hours after randomisation than those receiving inpatient care. The adjusted mean difference was 1,763 steps (95% CI 153–3,373; P=0.03).

Participants in the hospital-at-home group also spent a greater proportion of time in active movement zones than those in the brick-and-mortar group (15.6% vs 8.6%; P=0.001).

Satisfaction scores were higher among hospital-at-home participants, with mean scores of 4.41 versus 4.10 for inpatient care (P=0.04). Perceived safety scores remained high in both groups and did not differ significantly.

No statistically significant differences were observed in mortality at days 7, 30 or 90; in readmission rates at 30 or 90 days; or in adverse events during admission. However, the authors noted that the trial was not powered to detect differences in safety outcomes and that confidence intervals were wide.

Limitations and next steps to support clinical practice

Key limitations included the inability to blind participants and clinicians, the relatively small sample size, the absence of frailty assessment and a protocol deviation that restricted physical activity analyses to the first 24 hours after randomisation rather than the planned longer monitoring period.

Physical activity was also considered a surrogate endpoint rather than a direct clinical outcome, the authors added.

Larger multicentre studies are now warranted to determine whether increased activity translates into improved clinical outcomes.

The authors said that future research should include frailty measures, functional outcomes, longer-term activity monitoring and health-economic analyses, while also evaluating the scalability and implementation of hybrid hospital-at-home models within routine healthcare systems.

Reference
Larsen MN et al. Hybrid Hospital at Home and Physical Activity for Adults Admitted to the Hospital With Acute Illness: A Randomized Clinical Trial. JAMA Netw Open 2026;9(6):e2618812.