ARTICLE: Hospital Quality Care, Home Comforts, Better Outcomes
Wed, 16 Sep 2015
Providing high quality care to acutely ill older adults remains one of the most vexing challenges in health care. How can providers adequately meet the needs of a patient who is too infirm to even visit their health care practitioner? In addition to the simple logistical problems presented by caring for older patients, care for acutely ill older adults is often costly, while the stress brought on by the visit itself can unintentionally worsen an older patient’s condition.
Johns Hopkins Hospital at Home® is a groundbreaking model for health care organizations that allows them to address challenge of caring for acutely ill elderly patients. Conceived in 1995 by Dr. John Burton of the Johns Hopkins School of Medicine and Dr. Donna Regenstreif of The John A Hartford Foundation, with further development by Dr. Bruce Leff of Johns Hopkins Medicine, Hospital at Home® is a tool to provide cost-effective treatment for older adults while improving patient safety, quality and satisfaction.
Currently being implemented across the country at VA hospitals, health systems, and managed care programs, patients receiving care through Hospital at Home® experience better clinical outcomes with a lower average length of stay than similarly hospitalized patients. Additionally, Hospital at Home® allows older adults to remain in their homes while receiving care that advances the Triple Aim standard while providing cost savings of 19% to 30% when compared with traditional inpatient care.
Typically, the HaH® program follows these steps:
- A patient requiring admission for one of the target illnesses is identified in the Emergency Department or ambulatory site. Staff assesses if the patient is a good candidate for the program using the validated criteria.
- If the patient is eligible and consents to participate, the Hospital at Home® physician evaluates the patient and is transported home, often by ambulance.
- Once home, the patient receives extended nursing care for the initial portion of their admission, and then at least daily nursing visits according to clinical need. Nurses are available 24 hours a day/7 days a week for any urgent or emergent situation.
- The patient is evaluated daily by the Hospital at Home® physician who completes an assessment and continues to implement appropriate diagnostic and therapeutic measures. The physician makes one or more home visits per day and is available 24 hours a day/7 days a week for any urgent or emergent situation.
- The clinicians use care pathways, including illness-specific care maps, clinical outcome evaluations, and specific discharge criteria.
- The patient can receive diagnostic studies such as electrocardiograms, echocardiograms, and x-rays at home, as well as treatments, including oxygen therapy, intravenous fluids, intravenous antibiotics, and other medicines, respiratory therapy, pharmacy services, and skilled nursing services.
- Diagnostic studies and therapeutics that cannot be provided at home, such as computerized tomography, magnetic resonance imaging, or endoscopy, are available via brief visits to the acute hospital.
Treatment continues until the patient is stable for discharge; once they are discharged, care reverts to the patient’s primary care physician.
Hospital at Home® provides a level of care previously unavailable outside of a hospital. It is safe, effective and cost-efficient, while preserving the dignity and comfort of the patient. It is a revolution in geriatric care, from the comfort of the patient’s couch.