Hospital at Home telehealth programs enable patients to receive hospital level care and telehealth and RPM services in the comfort of their own homes.

The COVID-19 pandemic has highlighted wide disparity and gaps in the US healthcare system, including the capacity of our hospitals and health systems to meet patient needs. As our country continues to struggle with accelerating cases, it is essential that all stakeholders understand the Hospital at Home model --  who it benefits, and how. 

New York City saw an escalating COVID crisis early on. Hospitals were overrun and there were insufficient beds and staff - for COVID-19 patients and others requiring hospital care. Now, US hospitals in smaller cities across the country are experiencing these shortages. In both Lafayette and Lake Charles Louisiana all major hospitals are at or  near full capacity. The ICU at St. Luke’s in Boise, Idaho is running at 130% normal capacity. The examples are compounding of maxed out hospital capacity throughout the nation as more hotspots emerge.

How a Hospital at Home Model Helps

Hospital at Home programs have benefited primarily those with non- COVID-19 conditions. However, for some patients with COVID-19 (lower risk, stable), the Hospital at Home model can enable patients to leave the hospital earlier than otherwise would have been possible without a technology option to support them during their recovery.

Keeping patients out of the hospital who do not need to be there or can receive the same level of care at home will be essential for mitigating the burden on hospitals across the country. In addition, Hospital at Home  empowers patients to receive care at home, a delivery method that has been proven to improve patient satisfaction and outcomes.

Michigan Medicine’s Hospital Care at Home Program

Michigan Medicine recently launched its Hospital Care at Home Program. The program begins with identification of patients who can safely return home from Michigan Medicine’s emergency department as opposed to being admitted to the hospital. The Hospital Care at Home program includes collaborative work with Michigan’s Medicine’s Home Care division (Michigan Visiting Nurses and HomeMed Infusion Pharmacy program) and Huron Valley Ambulance Service of Emergent Health Partners and Binson’s Medical Equipment. 

To be included in the program, the patient must fulfill predetermined criteria (certain MI counties, certain conditions, inpatient stay qualification). Once enrolled,  the patient is transported via Huron Valley Ambulance to their home. Once home, the patient receives “a range of home-based care -- including blood draws, X-rays and medication infusions – through visits from trained staff including a physician, nurses and nurse practitioner, a home health aide and a physical therapist if needed. They [are] loaned a digital tablet and a kit of electronic remote patient monitoring devices that can monitor their vital signs and transmit the data to nurses who can coach them and act on changes. A physician and paramedics are on call for urgent needs.”

Michigan Medicine also offers the program to patients already in the hospital who are eligible to go home early and receive care and support at home. This workflow allows Michigan Medicine to make the best use of its hospital beds and mitigates capacity strain. 

Michigan Medicine’s program is one that hospitals around the country can, and should, consider for replication in their own communities. 

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Supported in the Research

A Cochrane Review study from 2016  evaluated the efficacy of the Hospital at Home model compared to traditional inpatient hospital care. Researchers examined both the effectiveness and the cost and found no difference in 6-month mortality, no difference in being transferred or remitted to a hospital, along with lower costs, and higher satisfaction with the healthcare received. In this study, the reasons for hospitalization varied and included COPD, stroke, cellulitis, fever and neutropenia, dementia, and neuromuscular disease.

The COVID-19 Pandemic and Beyond

The benefits of Hospital at Home programs during the current public health emergency would be substantial and already has been across many organizations. Hospital at Home programs help reduce the strain on hospitals, ensuring that hospitals have capacity for the patients who need aggressive inpatient intervention. 

Beyond the pandemic, the Hospital at Home model will prove substantial in helping patients age in place. Data clearly shows that individuals want to age in place. That desire, combined with the evidence that the Hospital at Home model is patient-centric, valuable and cost effective, should be reason enough for the adoption of the model across our nation’s hospitals and health systems.

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