Acute hospital-level care to older adults in the comfort of their home.
HOSPITAL AT HOME® SUCCESS STORIES
From Presbyterian Health Care
How can a health care organization provide high-quality hospital-level care to acutely ill older adults in their home that improves outcomes, reduces health care costs and enhances the patient experience?
Hospital at Home® is an innovative care model for adoption by health care organizations that provides hospital-level care in a patient’s home as a full substitute for acute hospital care. The program is being implemented at numerous sites around the United States by VA hospitals, health systems (including Presbyterian Health System), home care providers, and managed care programs as a tool to cost-effectively treat acutely ill older adults, while improving patient safety, quality, and satisfaction.
Hospital at Home® includes a range of tools to support adoption and implementation by any health care organization including:
Hospital at Home® was developed by researchers at the Johns Hopkins University Schools of Medicine and Public Health and successfully tested in a National Demonstration and Evaluation Study. Hopkins has successfully provided HaH adoption technical assistance to several health systems.
Johns Hopkins Hospital at Home is an innovative way for a hospital/health system to manage the health care of acutely ill older patients by treating them in the comfort of their own home rather than admitting them to the hospital. The concept was tested in a National Demonstration and Evaluation Study at several Medicare managed care sites and a VA Medical Center. It was the first implementation of the Hospital at Home model to completely substitute care in the patients’ home for acute inpatient care.
The results: cost savings of approximately 30 percent compared to traditional inpatient care; better clinical outcomes; lower average length of stay; fewer lab and diagnostic tests compared with similar patients in hospital acute care; and it advanced the Triple Aim of clinical quality, affordability and exceptional patient experience. The model has been more recently implemented in the Medicare managed care setting with similar published clinical outcomes and cost savings of 19%.
Hospital at Home allows an older adult with an acute illness to remain in the comfort of their own home and receive hospital level care. This care model helps older adults avoid common iatrogenic complications associated with stays in traditional acute care hospitals such as delirium, polypharmacy, functional decline, and others.
It’s feasible, safe, and efficacious for certain older patients with selected acute medical illnesses, who require acute hospital level care.
Dr. John Burton, of Johns Hopkins School of Medicine, and Dr. Donna Regenstreif of The John A Hartford Foundation conceived a new program to provide safe and effective hospital-level care in the home. A geriatric study team led by Dr. Bruce Leff developed medical eligibility criteria and the basic clinical model and designed the study and measurement methodology.
A 17-patient pilot trial showed the Hospital at Home® was feasible, safe, and cost effective.
A National Demonstration and Evaluation Study tested Hospital at Home® in three Medicare managed care organizations and one Veterans Affairs medical center. Hospital at Home® met disease-specific quality standards at rates similar to the acute hospital. The average patient length of stay was shorter, and overall costs were a third lower than an inpatient stay. Patients also had a lower chance of developing delirium, requiring sedatives, or needing chemical restraints. In addition, both patients and family members were more satisfied with care compared to those treated in the hospital, and family member stress was lower. Patients also regained their ability to do usual tasks more quickly.
Hospital at Home® is in practice or is being developed at numerous sites throughout the country, including:
A public/private partnership tested a modified model of Hospital at Home®, in which home-based care is provided by nurses, with physician consult via biometrically enhanced two-way telemedicine-video. The new model is also managed by a physician group, instead of a hospital.
Mount Sinai Medical Center, New York, is awarded an Innovation Challenge Grant from the Center for Medicare and Medicaid Innovation (CMMI) at the Center for Medicare and Medicaid Services (CMS) to develop HaH in a fee-for-service Medicare setting and to develop data to inform the future development of a 30-day bundled payment for HaH care.
Is your institution ready for a Hospital at Home program?
Organizations seeking to adopt innovative care models often need to develop new systems and roles, while overcoming resistance to change. To successfully implement Hospital at Home you will need to ensure that the conditions are right and that needed resources are readily available.
Ask yourself the following questions:
If you answered yes to one or more of these questions then Hospital at Home® may be appropriate for your organization.
A typical Hospital at Home® program follows these steps
The patient is treated until stable for discharge. When the patient is discharged by the Hospital at Home® physician, care reverts to the patient’s primary care physician.
Hospital at Home® in the News website
The Johns Hopkins Patient Guide to Diabetes– An on-line resource where you can find information about managing diabetes and its complications.
For 130 years, Johns Hopkins Hospital has led the way in both biomedical discovery and health care, establishing the standard by which others follow and build upon. This is one of many faculty-developed programs, protocols and services provided by Johns Hopkins HealthCare Solutions to improve health outcomes and reduce the cost of care.
Contact us to learn more about this solution and how it can benefit your organization.