A Resource Guide for Hospital at Home

As healthcare systems continue to face mounting pressure to improve care while reducing costs, the Hospital at Home model has gained increasing attention as an innovative solution to achieve these goals. Hospital at Home programs provide hospital-level care to patients in their homes and have been shown to be effective in reducing hospitalizations, improving patient outcomes, and lowering healthcare costs.

The Hospital at Home model has been in use for over 20 years and has gained increasing attention in recent years as healthcare systems look for ways to improve care and reduce costs. Hospital at Home programs typically involves multidisciplinary teams that provide medical, nursing and social support to patients who are deemed appropriate for home-based care. Today, there are many organizations, leaders, and resources dedicated to advancing the Hospital at Home model and promoting its adoption as a way to improve care and reduce costs for patients and healthcare systems alike.

Acute Hospital Care at Home, or Hospital at Home, is a healthcare model that provides hospital-level care in the patient's home instead of a traditional hospital setting. This approach aims to provide patients with high-quality care in a familiar and comfortable environment while reducing the cost of healthcare. The Hospital at Home model is often used for patients with acute illnesses or exacerbations of chronic conditions that require hospitalization, but who do not need the full range of services provided by a hospital.

There are several elements that are critical to the success of implementing a Hospital at Home program:

Patient Selection - Hospital at Home programs are designed for patients who would otherwise require hospitalization but can safely receive care in their home environment. Therefore, selecting the appropriate patients is critical. Patients with certain medical conditions, such as heart failure, pneumonia, cellulitis, or chronic obstructive pulmonary disease, are typically good candidates for this type of care.

Interdisciplinary Team - A Hospital at Home program requires a team-based approach to care. The team typically includes a physician, nurse, pharmacist, and other healthcare professionals who work together to provide coordinated care. The team should be trained to work collaboratively and communicate effectively to ensure high-quality care.

Technology and Equipment - Hospital at Home programs require specialized technology and equipment to monitor patients remotely, including telemedicine and remote monitoring systems. This technology allows healthcare providers to monitor patients' vital signs, symptoms, and medication adherence in real time and respond quickly to any changes in their condition.

Protocols and Processes - Hospital at Home programs require well-defined protocols and processes to ensure patient safety and quality of care. This includes protocols for patient assessment, medication management, infection control, and emergency response.

Patient and Caregiver Education - Patients and their caregivers must be educated on the program's goals, expectations, and processes. This includes providing training on how to use any equipment or technology required for care, as well as instructions on when to seek emergency care.

Strong Partnerships - Hospital at Home programs require strong partnerships with local healthcare providers, including hospitals, primary care providers, and home health agencies. Additionally, there are virtual partner resources, like Corstrata, for wound and ostomy care. These partnerships help ensure smooth transitions of care and coordination of services to provide the same hospital level of care, in the home.

Continuous Quality Improvement - Hospital at Home programs require ongoing monitoring and evaluation to ensure that they are meeting the needs of patients and achieving the desired outcomes. This includes regular audits of processes, tracking of patient outcomes, and incorporating feedback from patients, caregivers, and healthcare providers to improve the program over time.

Go-To Resources & Publications

There are several “go-to” resources and publications available that support the development and implementation of a successful Hospital at Home program. Here are some examples:

1. Hospital at Home - This site is an online resource for Hospital at Home programs and provides information on best practices, research, and tools for program development. The website is managed by the Hospital at Home International Society.

2. Moving Health Home - Moving Health Home (MHH) is a coalition made up of stakeholders working to change federal and state policy to enable the home to be a clinical site of care.

3. Advanced Care at Home Coalition - This coalition, comprised of industry leaders in home and hospital care, advocates for all patients treated in U.S. hospitals who could safely receive care in their homes.

4. The American Hospital Association (AHA) - The AHA offers resources and publications related to Hospital at Home programs, including case studies and implementation guides.

5. The Journal of Hospital Medicine - This peer-reviewed journal publishes research related to Hospital at Home programs and other topics related to hospital medicine.

6. The National Home-Based Primary Care and Palliative Care Network - This organization provides resources and support for home-based primary care and palliative care programs, including Hospital at Home programs.

7. The Medicare Learning Network - The Medicare Learning Network offers resources and publications related to Medicare policies and programs, including waivers that may be relevant to Hospital at Home programs.

8. The Center for Medicare and Medicaid Innovation (CMMI) - CMMI is a federal agency that tests and evaluates innovative payment and service delivery models, including Hospital at Home programs.

9. The Agency for Healthcare Research and Quality (AHRQ) - AHRQ offers resources and tools related to quality improvement and patient safety, including resources that may be useful for Hospital at Home programs.

These resources and publications can provide valuable information and guidance for organizations looking to develop and implement a successful Hospital at Home program.

Hospital at Home Leaders

Additionally, there are numerous leaders and pioneers in the Hospital at Home movement who have led the charge and gathered the pertinent research data to validate the effectiveness and sustainability of this model, including:

1. Dr. Bruce Leff - Dr. Leff is a geriatrician and the director of the Center for Transformative Geriatric Research at Johns Hopkins University. He is a leading expert on Hospital at Home programs and has conducted extensive research on the model.

2. Dr. David Meltzer - Dr. Meltzer is a hospitalist and health economist at the University of Chicago. He has been a strong advocate for Hospital at Home programs and has conducted research on the model's effectiveness.

3. Dr. Eric Coleman - Dr. Coleman is a geriatrician and the director of the Care Transitions Program at the University of Colorado. He has been a leading advocate for care coordination and has conducted research on Hospital at Home programs as a way to improve care transitions.

4. Dr. David Levine - Dr. Levine is a general internist and researcher at Brigham and Women's Hospital in Boston. He has conducted research on the effectiveness of Hospital at Home programs and has advocated for their use as a way to reduce healthcare costs and improve outcomes.

5. Dr. Albert Sui - Dr. Sui is professor and chair emeritus of geriatric and palliative medicine, and a professor of medicine and population health science and policy at the Icahn School of Medicine at Mount Sinai and serves as the director of Mount Sinai at Home, having ed early trials bundling the hospitalization care with one month of post-discharge assistance that was foundational to the Hospital at Home model.

6. Dr. Pippa Shulman - Dr. Eliza “Pippa” Shulman is the Chief Medical Officer of Medically Home, a tech-enabled services company, that provides capabilities for patients to receive hospital care at home. She previously led the Center for Healthcare Innovation at Atrius Health and was also the Chief of Geriatrics and Palliative Care at Harvard Vanguard Medical Associates, leading value-based initiatives in an ACO as well as multiple improvement efforts in-home care.

7. Dr. Karen Joynt Maddox - Dr. Joynt Maddox is a cardiologist and health policy researcher at Washington University in St. Louis. She has conducted research on the effectiveness of Hospital at Home programs for patients with heart failure and has advocated for their use as a way to improve care for this population.

8. Dr. Jeffrey Rakover - Dr. Rakover is the medical director of the Hospital at Home program at NewYork-Presbyterian Hospital in New York City. He has been a leader in the development and implementation of Hospital at Home programs and has helped to establish best practices for the model.

Hospital at Home Organizations

There are several prominent organizations related to Hospital at Home or "Moving Health Home" that are working to advance the model and promote its adoption. Some of these organizations include:

1. Hospital at Home International Society - This society is dedicated to promoting Hospital at Home programs worldwide and provides resources, education, and networking opportunities for its members.

2. Home-Based Primary Care and Palliative Care Network - This organization focuses on home-based primary care and palliative care and provides resources and support for organizations implementing Hospital at Home programs.

3. American Hospital Association - The American Hospital Association (AHA) is a national organization that represents and advocates for hospitals and healthcare systems. The AHA has a Center for Health Innovation that is focused on advancing innovative care models, including Hospital at Home.

4. National Association for Home Care and Hospice - This organization represents home care and hospice agencies and provides resources and advocacy for the home-based care industry.

5. Centers for Medicare & Medicaid Services - The Centers for Medicare & Medicaid Services (CMS) is a federal agency that oversees the Medicare and Medicaid programs. CMS has implemented several programs and waivers related to Hospital at Home, including the Hospital Without Walls program and the Acute Hospital Care at Home waiver.

6. National Home-Based Care Council - This organization represents the home-based care industry and works to advance policies and regulations that support the growth of home-based care models, including Hospital at Home.

Hospital at Home Outcomes Publications

In recent years, numerous studies have demonstrated the clinical and financial benefits of the Hospital at Home model. For example, a 2018 study published in the Journal of the American Geriatrics Society found that Hospital at Home programs led to significantly lower rates of hospital readmission and higher patient satisfaction compared to traditional hospital care. Another study published in JAMA Internal Medicine in 2020 found that Hospital at Home programs were associated with lower costs of care and similar or better clinical outcomes compared to inpatient hospital care.

In addition to these clinical benefits, Hospital at Home programs have also been shown to offer significant financial benefits for healthcare systems. A study published in the Journal of Hospital Medicine in 2016 found that Hospital at Home programs led to a 19% reduction in costs per episode of care compared to traditional inpatient hospital care. Another study published in the Journal of the American Geriatrics Society in 2019 found that a Hospital at Home program saved an average of $8,000 per episode of care compared to traditional inpatient hospital care.

Overall, these outcomes data suggest that Hospital at Home programs have the potential to improve patient outcomes, patient/caregiver satisfaction, and reduce healthcare costs, making them a promising model for the future of healthcare delivery.

• Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. J Am Geriatr Soc. 2018;66(2): 328-335. doi:10.1111/jgs.15270

• Leff B, Burton L, Mader SL, et al. Hospital at Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients. Ann Intern Med. 2005;143(11):798-808. doi:10.7326/0003-4819-143-11-200512060-00008

• Shepperd S, Iliffe S, Doll HA, et al. Admission Avoidance Hospital at Home Cochrane Database Syst Rev. 2016;9(9): CD007491. doi:10.1002/14651858.CD007491.pub2

• Steventon A, Patel D, Rice N. NHS Hospital At Home: A Qualitative Study of Patient Experiences and Views. Br J Gen Pract. 2018;68(676):e778-e784. doi:10.3399/bjgp18X698657

• Shepperd S, Doll H, Angus RM, et al. Avoiding Hospital Admission Through Provision of Hospital Care at Home: A Systematic Review and Meta-Analysis of Individual Patient Data. CMAJ. 2009;180(2):175-182. doi:10.1503/cmaj.080763

• Caplan GA, Coconis J, Board N, Sayers A, Woods J. Does Home Treatment Affect Delirium? A Randomized Controlled Trial of Rehabilitation of Elderly and Care at Home or Institutional Care. J Am Geriatr Soc. 2006;54(5): 856-861. doi:10.1111/j.1532-5415.2006.00703.x

• Shepperd S, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2013;1:CD000313. doi:10.1002/14651858.CD000313.pub5

• Wong RY, Miller C, Shojania KG. Reducing length of stay with a same-day admission discharge system. Healthc Q. 2008;11(2):81-87. doi:10.12927/hcq.2008.19630

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