1. Background
The Hospital at Home model was develop ed 30 years ago by Dr. Bruce Leff and his colleagues at Johns Hopkins schools of medicine and public health. While some patients clearly require traditional intensive care, Dr. Leff believed that “home hospitalizations” could be safer, less expensive and more effective for select cases.
The Johns Hopkins team limited its study to four diagnoses: heart failure, exacerbation of emphysema, some types of pneumonia, and a bacterial skin infection called cellulitis.
2. Promising Findings
Published in The Annals of Internal Medicine, the promising finds caught the attention of other hospital systems. Many VA medical centers now offer the program, and variations of the model are becoming standard for care in Canada, Australia and other countries.
According to Next Avenue, a nonprofit news site that covers issues related to aging, multiple studies show the model:
A Harvard Business Review article describes the programs as “among the most studied innovations in health care.”
The model gained momentum last year when COVID-related cases overwhelmed many health systems. In November 2020, the Centers for Medicare and Medicaid Services launched an effort to expand hospital-at-home care nationwide.
3. How it Works
At Roper St. Francis Healthcare, patients will be screened for eligibility after they arrive at the emergency department. If they’re eligible for — and agree to — Hospital at Home, guidelines will be in place for treatment protocols.
The care team will coordinate laboratory work and imaging; order prescriptions, infusions or intravenous drips; schedule physical, occupational or speech therapy; provide food service, if needed, or transportation.
They’ll also schedule home visits with a nurse, community paramedic, or community health worker, which allows care teams to address the social determinants that exacerbate health challenges. By being in the home, they’re able to evaluate what patients need immediately and what should be in place for the long-term.
At the end of a home hospitalization, discharge protocols cover plans for continuing care.
4. The Technology
In-person support services, along with advanced technology, ensure that patients receive the same level of care as they would in a traditional hospital setting — except the care is virtual.
Most patients will receive an iPad or other tablet with monitoring programs in place. Clinicians can receive patient readings for everything from temperature and blood pressure, to weight loss or gain.
Roper is planning a 24⁄7 medical command center to provide constant connectivity — which means care team members can check on patients via phone call, video chat or text, and patients can connect with them. If anything is amiss, the issue will escalate up the care team ladder, ending with the lead physician when needed.
Many hospitals contract with vendors to provide equipment and support.
5. Next Steps
The program team at Roper St. Francis Healthcare is busy working through challenges such as establishing a supply chain for in-home services and developing the command center infrastructure.
They expect to launch Hospital at Home later in 2021, but the early program will be limited to patients needing care for cellulitis. Eventually, it will expand to patients who have been diagnosed with congestive heart failure, chronic obstructive pulmonary disease (COPD) or pneumonia.
Based on yearly averages, that would cover about 30 percent of the target diagnoses that are treated at the hospital — which means 600 patients a year could be cared for by the Hospital at Home program, says Troy Powell, vice president of Operations-Continuing Care.
Down the road, Powell expects the program will expand beyond the Tri-County Charleston area to serve other areas in need.
6. Reaching Success
With The Duke Endowment’s grant, key performance metrics include reduced cost of care, better patient outcomes and improved patient satisfaction. Says Little: “I want patients to honestly say, ‘I never want to stay in the hospital again.’”
