As the world continues to evolve, so too does the way healthcare is delivered to meet new demands and opportunities. This change is driven by advancements in technology, a growing emphasis on whole person-centered care, and the need to reduce healthcare costs. As these advancements are embraced, a future is closer where quality healthcare is accessible to all, regardless of location. By bringing care to the home, patient satisfaction can be enhanced, sustainable healthcare system. This paradigm shift not only empowers patients to engage with their care in a new way but also opens new avenues for healthcare providers to deliver innovative and effective treatments.
ChristianaCare recognized that improvements to traditional healthcare are possible and has embraced a digitally enabled approach that transcends the limitations of encounter-based care. The goal is to build a virtual health system that meets patients wherever they are located, providing comprehensive care across the continuum. This transformation allows for the delivery of healthcare services in innovative ways, ensuring that patients receive the highest quality of care, regardless of location.
Long before the COVID-19 pandemic, ChristianaCare recognized the potential for patient care to be delivered in the home. ChristianaCare envisioned a future where technology could be harnessed to improve both the quality and safety of treatments provided outside the traditional hospital environment. This foresight set the stage for rapid digital transformation when the pandemic struck, pushing us to achieve in three weeks what we had originally planned to accomplish over three years. The swift pivot to telehealth, characterized by the adoption of video and phone consultations, was driven by a commitment to patient and caregiver safety. To support this transition, the health system equipped all ambulatory and primary care practices with virtual care tools and provided comprehensive training to ensure a seamless experience for all involved.
The pandemic’s acceleration of telehealth adoption also opened the door for ChristianaCare to participate in the Acute Hospital Care at Home waiver. This program, approved by the Centers for Medicare and Medicaid Services (CMS), allows ChristianaCare to deliver hospital-level care directly to patients’ homes. The CMS waiver was instrumental in paving the way for a hospital at home programs to have a strong emphasis on quality and patient safety. To monitor the program’s impact, CMS requires mandatory reporting of quality and safety metrics, ensuring that the highest standards of care are maintained.
In addition to meeting CMS’s required measures, the Hospital Care at Home program tracks various criteria to evaluate its impact on patient outcomes. Over the past 2 years results have been promising, with significant reductions in readmissions, only one hospital-acquired infection, and patient satisfaction scores that far exceed those of traditional hospital settings. These outcomes underscore the effectiveness of this approach and highlight the potential for home-based care to achieve superior results compared to conventional inpatient care (Cryer et al.,2012).
The goals of hospital-at-home programs are multifaceted, focusing on improving patient satisfaction and quality of care, reducing readmissions, and lowering overall healthcare costs (Bloom-Feshbach et al., 2021). In this program, patients receive care in an environment that is both comfortable and safe. This approach is supported by a dedicated, expert team, led by a virtual hospitalist. A member of this virtual hospitalist team is available around the clock to oversee the patient’s care (Bloom-Feshback et al.,2021). The virtual care provided is supplemented by in-home services, including twice-daily nurse or paramedic visits and visits from other specialists, such as physical therapists, phlebotomists, and radiology technicians. This comprehensive care model ensures that patients receive the same level of attention and support as they would in a traditional hospital setting, but with the added benefits of being in their own homes.
Since the program’s inception, ChristianaCare has cared for over 1,200 patients, learning valuable lessons along the way. Patients that are eligible for the program have either Medicare or another contracted medical insurance and live in the geographical range of northern Delaware. One of the most significant insights into the program, has been the realization that patients receive safe, high-quality, and cost-effective care at home. Moreover, patient satisfaction rates have soared, reflecting the positive impact of this innovative approach on the overall patient experience.
A key focus of the hospital-at-home program is the seamless transition of care, ensuring that patients receive continuous, hospital-level services even after a significant healthcare event or hospitalization. This model is designed to enhance patient comfort, promote healing, and reduce the risk of readmissions. To achieve these goals, a comprehensive discharge plan is created for each patient, which includes medication management, follow-up appointments, and patient education. A strong emphasis is placed on clear communication, ensuring that essential information such as diagnoses, test results, and medication lists are shared effectively with both patients and caregivers. This coordinated approach between hospital staff and hospital-at-home providers ensures continuity of care, with regular communication to address any issues and adjust care plans as needed.
In addition to the core medical services, the Hospital Care at Home program includes a range of support services designed to address the holistic needs of patients. These services may include social work, nutrition counseling, and physical therapy, all of which contribute to the overall well-being of the patient and help reduce the likelihood of complications or readmissions. By addressing the full spectrum of patient needs, we aim to provide a more comprehensive and patient-centered approach to healthcare.
Implementing a hospital-at-home program can significantly improve patient outcomes by providing personalized, high-quality care in a familiar environment (Caplan, et al.,2012; Augustine et al.,2021). This approach also helps alleviate the strain on hospital resources, offering a cost-effective alternative to traditional inpatient care. One unique benefit of delivering hospital care at home is gaining insight into the social determinants of health within the patient’s home setting. This perspective allows us to connect with and leverage other community services more effectively, addressing factors that may influence the patient’s overall health and well-being.
However, implementing a hospital-at-home program is not without its challenges. One of the primary difficulties we encountered was finding and managing vendors to support in-home care. The logistics of coordinating multiple vendors in the external market can be complex, requiring careful planning and oversight. For primary in-home clinicians, hospital-at-home currently relies on nurses and have collaborated with the State of Delaware to develop a mobile integrated healthcare model, that leverages the expertise of paramedics to deliver care in the home.
Another challenge we face is finding patients that are clinically appropriate for the program and are willing to be admitted to their home. This proved to be more difficult than anticipated. Considerable time and resources have been invested in identifying suitable patients for the program, but this process has been more time-consuming than expected. To address this issue, we are working closely with brick-and-mortar colleagues to establish a more efficient process for referring patients to the program. This will allow the team to focus more on delivering in-home care rather than on patient acquisition.
ChristianaCare is committed to transforming traditional healthcare by leveraging technology and guiding patients through the transition into the Hospital Care at Home program. This program, supported by the CMS waiver, uses an approach that exemplifies hospital-level care at home, reducing readmissions, and achieving outstanding patient satisfaction. With a dedicated team available 24/7 and comprehensive in-home services, seamless transitions and holistic support is ensured, demonstrating that home-based care can be both effective and cost-efficient. As ChristianaCare continues to refine and expand this program, it remains focused on its mission to deliver exceptional care to patients, wherever they are.
References
Augustine, M. R., Siu, A. L., Boockvar, K. S., DeCherrie, L. V., Leff, B. A., & Federman, A. D. (2021). Outcomes of hospital at home for older adults with and without high levels of social support. Home Healthcare Now, 39(5), 261–270. https://doi.org/10.1097/NHH.0000000000000980
Bloom-Feshbach, K., Berger, R. E., Dubroff, R. P., McNairy, M. L., Kim, A., & Evans, A. T. (2021). The virtual hospitalist: A critical innovation during the COVID-19 crisis. Journal of General Internal Medicine, 36(6), 1771–1774. https://doi.org/10.1007/s11606-021-06675-y
Caplan, G. A., Sulaiman, N. S., Mangin, D. A., Aimonino Ricauda, N., Wilson, A. D., & Barclay, L. (2012). A meta-analysis of “hospital in the home”. The Medical j\Journal of Australia, 197(9), 512–519. https://doi.org/10.5694/mja12.10480
Cryer, L., Shannon, S. B., Van Amsterdam, M., & Leff, B. (2012). Costs for ‘hospital at home’ patients were 19 percent lower, with equal or better outcomes compared to similar inpatients. Health affairs (Project Hope), 31(6), 1237–1243. https://doi.org/10.1377/hlthaff.2011.1132
