Pioneering hospital-at-home in Taiwan: early clinical outcomes from the first cohort of nursing home older adults.

Objective: This study provides the first empirical evaluation of Taiwan's Hospital-at-Home (HaH) pilot program, launched in 2024 under the National Health Insurance system. The aim was to examine the clinical effectiveness, safety, and economic feasibility of HaH in managing acute infections, including pneumonia, urinary tract infections (UTIs), and soft tissue infections (STIs), among older adults living in long-term care facilities. Methods: A prospective, matched-controlled study was conducted from July 2024 to June 2025 across seven nursing homes. Sixty residents aged 65 years or older who received HaH care were matched in a 1:2 ratio with 120 hospitalized patients by age, sex, and diagnosis. HaH services were delivered by a single interdisciplinary team. Primary outcomes included care duration, medical costs (USD), emergency department (ED) revisits, readmissions, and mortality. Secondary outcomes were complication rates. Statistical analyses used Chi-square tests, t-tests, and Mann-Whitney U tests, with odds ratios and 95% confidence intervals reported. A p-value < 0.05 was considered significant. Results: HaH patients had significantly shorter care episodes compared with hospitalized patients (6.6 ± 1.5 vs. 11.8 ± 6.0 days, p < 0.001) and lower medical costs across all diagnoses. For STIs, costs were reduced by 65.1% (USD 979 vs. 2,805, p < 0.001), while UTIs and pneumonia showed savings of 46.0% and 45.5%, respectively. Overall clinical outcomes, including ED revisits, readmissions, and mortality, were similar between groups. In the STI subgroup, HaH patients had a significantly lower 14-day ED revisit rate (7.4% vs. 27.8%, odds ratio 0.21, 95% confidence interval 0.04-0.99, p = 0.04). HaH patients also experienced fewer hospital-acquired complications, particularly gastrointestinal and neurological events. Conclusion: The findings demonstrate that HaH is a safe, effective, and cost-efficient alternative to hospitalization for acute infections in institutionalized older adults. By reducing care duration and costs without compromising clinical outcomes, HaH offers a patient-centered model that can ease healthcare system pressures in rapidly aging societies. These results support further expansion of HaH in Taiwan and encourage additional longitudinal studies to confirm long-term benefits and broader health system impacts.