What is Hospital At Home?
The hospital is often regarded as the sole beacon of health – the one environment
where patients and practitioners can tackle medical issues. But for some patients,
particularly those with acute conditions, the best place to receive care is within their own
home. This practice, called the Hospital-At-Home (HaH) model, can reduce expenses
and allow patients with specific treatment plans to find comfort in their medical journeys.
The History of Hospital-At-Home
While private and personal medicine has existed for centuries, this differs from the HaH
model in that it is widely inaccessible. HaH is also distinct from patient
self-administration, as it merely shifts the setting, not the provider. In HaH programs,
hospital-level care is still provided through physician and nurse visits and other
elements of traditional medical centers.
One of the first HaH models in the United States emerged in 1995, as a project of Dr.
John Bueron of Johns Hopkins School of Medicine and Dr. Donna Regenstrief of The
John A Hartford Foundation. The two recognized the need for immediate and
convenient care for select patients and the simultaneous danger of exposing such
patients to infections and other risks associated with hospitals. Their solution, an
“integrated system” that offers “an alternative venue for patients requiring inpatient care,” “decompresses traditional hospitals to allow the sickest patients to be cared for
there.”
The Expansion of Hospital-At-Home
This opportunity rang particularly powerful during the COVID-19 pandemic. With limited
equipment, accommodations, and staff, hospitals were forced to find new avenues for
administering care. HaH programs posed a promising future. By isolating patients into
their homes, the HaH model safeguarded many patients from contracting the disease,
enabled these individuals to still receive care, and reserved hospital beds for those
suffering from the illness. The pandemic revealed the several facets of favorability
attributed to these programs, and accelerated their growth and implementation. On
November 25 of 2020, for instance, the Centers for Medicare & Medicaid Services
announced the Acute Hospital Care At Home Program, which stipulated the steps that
hospitals can take to develop at-home treatment options. Across the nation, the
number of HaH programs leapt from around 12 to “186 hospitals belonging to 66
different systems as of October 2021.” In September of the next year, the American
Hospital Association reported that 114 systems with 253 hospitals were approved to
administer HaH services.
The Implementation of HaH Models
The 2020 CMS waiver provided increased flexibility during the transition from
hospital-based care to the services provided within patients’ homes. It also regulated
the qualifying conditions for eligible patients. The scope of patients with compatible
circum stances and treatment protocols is limited. Although requiring “hospital-level
care,” these patients must “be considered stable enough to be safely monitored from
their homes.” Clear treatment plans, along with a demonstrated willingness, are ideal
among patients. In order to determine a patient’s eligibility, hospitals must conduct
in-depth evaluations based on narrow criteria, including illness status and psychological
health. Certain conditions also lend themselves better to HaH models, including chronic
obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cellulitis.
The following information was retrieved from the Johns Hopkins HaH model.
An Example workflow for set up:
Once identified as eligible, patients must submit their primary caregiver to review.
These individuals are then trained to carry out a patient’s prescribed procedures. A
social worker might also assess the patient’s home environment and confirm its
suitability in regard to internet access, air conditioning, heat, and running water. A
primary physician will then be assigned to a patient, along with a liaison with the given
hospital, who will develop communication and transportation methods with the patient.
The patient will meet with the physician to discuss their treatment options along with the
newly delivered medical supplies. Using Remote Patient Monitoring (RPM) devices, a
patient’s vitals can be reported and monitored by a care team. A provider also meets
daily with the patient.
The Benefits of HaH Models
Johns Hopkins Medicine, in many ways, pioneered early trials of HaH models. The
institution’s research, often with older patients, has informed many subsequent developments. The team’s model resulted in a significant cost reduction due to the
decreased number of laboratory tests and consultations. This change translated to a savings of approximately 30% compared to traditional inpatient treatment options. When modeled with the Medicare setting, the team found a 19% reduction. A broader review of 16 randomized HaH programs by Cochrane in 2016 also reported an overall cost reduction of 38%.
HaH systems also lead to higher quality of care. The Johns Hopkins report noted that “compared to similar hospitalized patients, HaH patients experience better clinical outcomes,” including decreased mortality rates and delirium medication use, along with greater patient and caregiver satisfaction.
The comfort that’s characteristic of at-home care is directly related to the patient experience; as with other telehealth and RPM programs, patients feel less stress when treated in their homes. This is especially true for patients with long-term plans, as they might rely on the sense of routine and normalcy. These factors are frequently related to lowered readmission rates.
As mentioned previously, there are many “stakeholders” in the continued use of HaH
models. While patients are perhaps most advantaged – in their increased satisfaction
and separation from hospitals – providers similarly benefit. Medical professionals are
given the freedom to remotely monitor and step in at any point. A patient’s caregiver,
often a family member, may also experience a better quality of life due to the comforting environment.
On a larger scale, some have drawn a connection between HaH opportunities and the
increase of health equity and access. Because of how tailored HaH programs can be,
patient factors that might otherwise be overlooked, including food insecurity and
economic disadvantages, can be identified and addressed. These social determinants
of health (SDOH), although seemingly nonmedical, have grave impacts on how a
patient can access and utilize their care. For more information on the importance of the
SDOH within RPM, check out our post on technical support.
The Barriers of HaH Models
Along with the restrictions on which patients are eligible for these programs, there are
several other challenges facing current HaH systems. The reliance on outside
caregivers, for instance, is at times troublesome. Although trained by medical
professionals, these caregivers lack extensive experience and, thus, can hinder the
efficiency and safety of HaH models. There are many moving parts involved, which can
function seamlessly when properly executed, but just as easily result in issues, such as
the failure to transport medications.
HaH also depends on sufficient internet/cellular access, which can delay important information and impede patients in more rural areas.
How Impilo Can Help
Impilo’s integrated RPM device systems are a great solution for delivering hospital-level
care in the comfort of a patient’s home. Providers can conveniently monitor a patient's
vitals without the hassle, and at times danger, of an in-person visit. With the help of
Impilo, decrease your expenses and increase your satisfaction through HaH programs!
Contact sales@impilo.health to learn more!