Hospital-at-home for acute complicated diverticulitis: a single-arm feasibility study
Bibliographic record
Abstract
INTRODUCTION: Non-operative management (NOM) of acute complicated diverticulitis (ACD) has become the preferred approach. A Hospital-at-Home (HaH) program at our institution launched to provide NOM for ACD. This study evaluated the HaH program feasibility for well-selected patients. METHODS: Prospective single-arm single-institution non-randomized feasibility study conducted from 10/2022 to 10/2023. Patients in the Emergency Department (ED) with ACD who met inclusion criteria (> 18 years, hemodynamically stable, caregiver at home, technology proficiency, within 10 km of service center within health network) were admitted to HaH instead of hospitalization. Participants wore devices measuring vitals, were contacted by a nurse TID, and had a virtual physician visit ≥ qd. At-home phlebotomy, IV fluids/antibiotics , priority outpatient imaging, percutaneous drainage, and PICC were available. The program ended once patients met discharge criteria or were transferred to the ward for planned surgery. Primary outcome was feasibility defined as 60% of participants not requiring unplanned healthcare visits 30 days post-discharge. Secondary outcomes included descriptive data, hospital bed-days saved, and unplanned healthcare visits at 60 days. RESULTS: Of 22 patients who met inclusion criteria, 10 were enrolled. Participants were 80% male, with mean age of 56 ± 9.3 years, and mean Charlson Comorbidity Index of 1.6 ± 1.4. CT revealed abscess (3.14 ± 1.7 cm) and extraluminal gas in 90 and 40% of participants, respectively. 70% received IV antibiotics alone, 10% required percutaneous drainage, and 20% required surgery. Of the 10, 6 had resolution without further care, 2 progressed to semi-elective surgery, and 2 failed the program for ED presentation within 7 days of discharge. The HaH program had an 80% success rate. Median length of stay was 9.5 (IQR 6.3-13) days, resulting in 98 saved hospital bed-days. CONCLUSION: Our novel HaH program for patients with ACD demonstrated feasibility with 80% of patients successfully completing it, suggesting that HaH is a viable alternative to inpatient care for ACD in well-selected patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".