Hospital at Home

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.

How was Hospital at Home developed?

1995

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.

1996-1998

A 17-patient pilot trial showed the Hospital at Home® was feasible, safe, and cost effective.

2000-2002

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.

2002-Present

Hospital at Home® is in practice or is being developed at numerous sites throughout the country, including:

• Presbyterian Health Services, Albuquerque, NM
• Centura Health Systems, Colorado Springs, CO
• Cedars Sinai Medical Center, Los Angeles, CA
• Veterans Affairs Medical Center, Boise, ID
• Veterans Affairs Medical Center, Honolulu, HI
• Veterans Affairs Medical Center, New Orleans, LA
• Veterans Affairs Medical Center, Philadelphia, PA
• Veterans Affairs Medical Center, Portland, OR
• Veterans Affairs Medical Center,Cincinnati, OH

2010

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.

2014 

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:

•  Is your health system experiencing problems from a lack of hospital capacity?
• Does your health system have establish home health-care delivery capabilities?
• Do you have physicians with the interest and ability to care for patients in the home environment?
• Does your health system experience a large volume of Medicare admissions for common problems such as community-acquired pneumonia, heart failure, or chronic pulmonary disease (COPD)?
• Does your institution view itself as an innovator in developing and implementing new models or systems of care?
• Can your health system align payment, providers, and the hospital to develop HaH?

If you answered yes to one or more of these questions then Hospital at Home® may be appropriate for your organization.

How does Hospital at Home® work?

A typical Hospital at Home® 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.

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.