January 2020

Hospital-Level Care at Home for Acutely Ill Adults

What was studied?
Researchers at Brigham and Women’s Hospital conducted a randomized controlled trial to determine the efficacy of a hospital at home model (vs. the traditional hospital setting). Researchers compared the outcomes of the home hospital versus hospital care for patients requiring admission, focusing specifically on cost reduction, readmission, and patient experience.

Ninety-one patients were enrolled in the study and randomized into either the control hospital group (n=48) or treatment home hospital (n=43) group. Each patient had been admitted via the ED with a select acute condition including infection, heart failure exacerbation, COPD or asthma exacerbation. The patients at home received acute care at home which included nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. The primary outcome evaluated the total direct cost of the acute care episode which was determined by the sum of costs for nonphysician labor, supplies, medications, and diagnostic tests. The secondary outcome included health care use and physical activity during the episode and at the 30-day mark.

Research Findings

• Cost for the treatment group was 38% lower than the control group
• Home patients were admitted less frequently within 30 days (7% vs. 23%)
• Home patients had fewer laboratory orders (median per admission, 3 vs. 15)
• Home patients had fewer imaging studies (median, 14% vs. 44%)
• Home patients spent less time sedentary (median, 12% vs. 23%)

Why do these findings matter?
This study supports the notion that home hospital care is a viable method of care delivery. Home hospital care meets the patients “where they are” – it is a patient-centric model that allows the patient to recover at home. Patients can be surrounded by their family and friends, in a familiar environment where they feel safe, can sleep in their own bed, and be comforted by what they’re used to (as opposed to jostled and stressed by the hospital setting)- all with the support of the home hospital team (MDs, nurses, aides, etc.).

The reduced cost of treatment for the home hospital group is notable and can be attributed to a combination of remote and in-person care, readmission reduction, and reduction in the use of ancillary services and consultations. While the patient-nurse ratio was similar between groups, the difference in labor is extreme (visits at home vs. 24-hour hospital care).

The results of this study are exciting and promising, as they strengthen the evidence that home hospital care can reduce cost, utilization and readmission, while also increasing physical activity and patient care.

Access the full article, here.

Date Published: January 2019
Levine, David M., et al. “Hospital-Level Care at Home for Acutely Ill Adults.” Annals of Internal Medicine, vol. 172, no. 2, p. 77, 2019.

Dementia Care Frameworks and Assistive Technologies for Their Implementation: A Review

What was studied?
This literature review, aims to outline the most successful integrated care models for dementia care management, leveraging healthcare technologies. Specifically, the studies examines the use of mobile, wearable, and home-based. The review outlines risks associated with dementia, current care models and assistive technologies for dementia management, trending research areas, and finally the cost effectiveness of existing models, evaluating evidence from previous research and studies.

Each assistive technology, mobile, wearable, and home-based, are evaluated across five applications: detection, diagnosis, and assessment; disease management and patient support; support of non-pharmacological interventions; support of communication and collaboration of care delivery actors; support of informal caregivers. Due to the prominent role of informal caregivers, the review paced an emphasis on how each care model and respective technology impacted caregivers of dementia patients.

Research Findings

• Cost effectiveness home-based assistive technologies for physical exercise and occupational therapy, as well as psychological and behavioral interventions
• Psychosocial interventions, across multiple assistive technologies, have proven effective in maintaining caregiver psychological health and delaying patient institutionalization
• Memory-support technologies increase independence and reduce loneliness of dementia patients.
• Despite growth in educational, psychosocial, and behavioral tools that impact both dementia patients and caregivers, assistive technologies must shift in focus to prioritize communication and collaboration of care
• Gaps in understanding of each specific type of assistive technology are hindering uptake by caregiver

Why do these findings matter?

Seven percent of the world's population over the age of 65 suffers from dementia, a chronic, progressive condition that consists of intellectual deterioration effecting a person's social and occupational functions. Not only does care for dementia patients utilize an enormous amount of resources within the healthcare industry, caring for dementia patients, more often than not, requires assistance from informal caregivers. The burden-sharing between formal healthcare systems and informal caregivers underscores the importance of communication and integrated care across providers.

The review, while admitting the need for further research in cost effectiveness, highlights the success of assistive technologies in improving patient and caregiver mental health and in delaying the institutionalization of dementia patients, a costly step both informal caregivers and healthcare systems.

Access the full article, here.

Date Published: January 2019
Susanna Spinsante, Annachiara Strazza, Ciprian Dobre, Lidia Bajenaru, Constandinos X. Mavromoustakis, Jordi Mongay Batalla, Piotr Krawiec, George Georgescu, Gregor Molan, Horacio Gonzalez-Velez, Anna Marie Herghelegiu, Gabriel Ioan Prada, Rozeta Draghici, "Integrated Consumer Technologies for Older Adults' Quality of Life Improvement: the vINCI Project",Consumer Technologies (ISCT) 2019 IEEE 23rd International Symposium on, pp. 273-278, 2019.

Patient and Clinician Experiences with Telehealth for Patient Follow-up Care

What was studied?
Massachusetts General Hospital (MGH) provided training to clinicians, across five departments, over a one year period, instructing them on how to perform virtual visits with patients. The five departments included psychiatry and psychology, neurology, cardiology, oncology, and primary care. Prior to their first virtual visit, patient received training and phone-based technical support for installation of the video software. The survey measured quality of virtual visits from the patient and clinician perspective, patient and clinician satisfaction, and patient willingness to pay for a virtual visit.

MGH's Telehealth Virtual Visit Program surveys 254 patients following a full year of implementation. Eligible patients had at least one virtual visit during the survey period and at least one office visit within 6 months prior to the survey period. Patients spanned a wide age range, with the majority of patients being 30 years and older, and 22% of patients being 65 and older.

Research Findings

• 62.6% of patients and 59% of clinicians reported “no difference” between virtual and office visits on “overall quality of the visit.”
• 54.6% of patients found the "personal connection" felt with their clinician was better of no different through a virtual visit
• 80.3% of clinicians stated that "workflow outside of the visit" was better if no different utilizing virtual visits
• 83.5‬% of patients responded they were willing to pay a copay of $10 - $25 for a virtual visit (yes, definitely, 65.4%; yes, somewhat, 18.1%)
• 36.2% of patients stated they were willing to cover the full cost of a virtual visit (yes, definitely, 18.1%; yes, somewhat, 18.1%)

Why do these findings matter? 

Similarly to the above study, this study from MGH makes a compelling argument towards the cost effectiveness of virtual visits, as well as an argument for patient preferences to receive care virtually.  

According to a 2018 US Census Bureau study, individual living in rural communities, or outside metropolitan statistical areas (MSAs), are less likely to have health insurance and access to public transportation. These barriers, along with lower health literacy and workforce shortages, present rural communities with access, affordability, and quality care challenges. 

More than 46 million Americans live in rural areas and face these barriers to care. This study from Massachusetts General Hospital underscores the viability of using virtual visits to provide comprehensive, quality care for patients across all ages and disease conditions. As well, the study presents an ROI argument for healthcare providers, as the majority of patients were willing to pay a copay for virtual visits - this number increased substantially the further patients had to travel to receive in-office care.

Access the full article, here.

Date Published: January 2019
Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA; Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD. "Patient and Clinician Experiences With Telehealth for Patient Follow-up Care." The American Journal of Managed Care, vol. 25, no. 1, 2019.