Bringing the Hospital to the Home

The initial few days following discharge are a critical and vulnerable time for the patient; one has to potentially adjust to understanding a serious diagnosis, a new medication regimen, and a change in one’s day-to-day lifestyle. Providing acute care in the home, post-discharge, can help the patient better acclimate to the new routine, engage in his/her care, and remain home vs. returning to the Emergency Department and/or being readmitted.

The Launch of Hospital at Home

Bruce Leff, MD, a Professor of Medicine at the Johns Hopkins University School of Medicine, published an article in the NEJM Catalyst about the Hospital at Home (HAH) and how acute care has successfully move from the hospital to the home. Starting in the mid-1990s, Johns Hopkins geriatrician Bruce Leff and colleagues pioneered a program to explore if an acute medical illness that normally requires hospital admission can be well managed in a patient’s home instead of the hospital. This resulted Hospital at Home (HaH) being implemented for three conditions – community-acquired pneumonia, acute worsening of heart failure or chronic obstructive pulmonary disease, and soft-tissue infections.

Early findings were quite positive with results such as fewer complications, greater patient and family member satisfaction, less caregiver stress, better functional outcomes and lower costs. In the first decade, a number of HaH type of studies continued to demonstrate that treatment at home had lower mortality than did hospital treatment, treatment periods were shorter, and costs were dramatically lower. A 2012 meta-analysis of randomized controlled trials of HaH showed a 38% lower 6-month mortality rate for HaH patients than hospitalized patients. Dr. Leff’s innovative care model has been well-regarded for its ability to replace acute hospital care by delivering hospital-level care in a patient’s home.

The Role of a Virtual Care Communication Platform

Bringing the hospital to the home concept is now easier and more efficient by leveraging technology such as a virtual care platform. Home health care providers can conduct virtual check-in’s with their patients in addition to (or instead of) typical in-person home visits. Also, staff can use the platform to regularly communicate with their patients via email, SMS, and text in order to support the patient with timely reminders about upcoming virtual visits as well as the prescribed medication regimen and required diet, exercise and lifestyle changes.

The communications can be designed based on the patient’s preference for modalities and language while leveraging the hospital’s disease-management programs and the home health agency’s workflow. By engaging patients with a series of virtual visits and messaging, home health agencies can cost-effectively treat discharged and/or chronic care patients while improving patient safety, quality, and satisfaction.

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