Hybrid Hospital at Home and Physical Activity for Adults Admitted to the Hospital With Acute Illness: A Randomized Clinical Trial.

Importance: Hospital-at-home (HaH) models may alleviate bed capacity constraints and reduce hospital-associated risks. Evidence on patient physical activity and patient experience in hybrid HaH for adults with acute conditions remains limited. Objective: To estimate whether a hybrid HaH model increases early physical activity and patient satisfaction without compromising safety or clinical outcomes compared with standard brick-and-mortar (BAM) care. Design, Setting, and Participants: This single-center, investigator-initiated nonblinded randomized clinical trial was conducted at 2 internal medical wards at a regional public hospital providing acute and emergency care in Denmark. Enrollment was from June 1, 2023, to January 31, 2025; follow-up continued to May 20, 2025. Adults (aged ≥18 years) admitted for acute illness were screened for eligibility. Key exclusions included unstable clinical condition, major physical or cognitive impairment, limited Danish proficiency, and pregnancy. Interventions: The hybrid HaH program (Influenzer) included remote patient monitoring via a patient-facing app and clinical dashboard with oversight 24 hours a day, 7 days a week; weekday virtual ward rounds; and home-based clinical tasks. BAM patients received standard inpatient care. Main Outcomes and Measures: Coprimary outcomes were physical activity during the first 24 hours after randomization and patient-reported satisfaction and perceived safety shortly after discharge. Secondary outcomes included mortality (7, 30, and 90 days), readmissions (30 and 90 days), and adverse events of special interest during admission. Results: Of 230 participants assessed for eligibility, 111 were randomized. The HaH model included 58 participants (median age, 64 [IQR, 50-75] years; 30 males [52%]); BAM included 53 participants (median age, 65 [IQR, 57-73] years; 28 males [53%]). HaH participants were significantly more physically active than BAM participants (adjusted mean difference, 1763 steps [95% CI, 153 to 3373 steps]; P = .03). Satisfaction was higher in HaH vs BAM (mean [SD] score, 4.41 [0.79] vs 4.10 [0.81]; mean difference, 0.31 [95% CI, -0.03 to 0.65]; P = .04), while perceived safety was similarly high across groups (mean [SD] score, HaH: 4.37 [0.88] vs BAM 4.23 [0.83]; mean difference, 0.14 [95% CI, -0.22 to 0.50]; P = .24). No significant differences were observed in any of the recorded safety events. Conclusions and Relevance: In this randomized clinical trial of adults receiving medical care for acute conditions at home, hybrid HaH was associated with greater early physical activity and patient satisfaction, with no signal of excess harm compared with BAM care. Future multicenter studies should incorporate frailty measures and assess durability and linkage to clinical end points. Trial Registration: ClinicalTrials.gov Identifier: NCT05920304.