Jacksonville, Fla.-based Nemours Children’s Health has expanded its Advanced Care at Home program across multiple states and more than doubled the number of children served since Becker’s last reported on the initiative.
When Becker’s covered the program in November, Nemours had cared for about 120 children and saved 177 inpatient days since its June debut. Since then, the program has scaled significantly in both patient volume and geographic reach.
“As of [March 5], we’ve had 265 unique patients,” Jane Mericle, DNP, RN, executive vice president, enterprise chief nursing executive and chief patient operations officer, told Becker’s. “Our average daily census is 140 now, but yesterday our census was 165.”
Nemours launched the model to rethink how pediatric patients transition between hospital and home. Many children are medically stable but still require close monitoring, which historically keeps them in inpatient beds longer than necessary.
“Advanced Care at Home was launched with a desire to help children that could heal and recover in their home do that,” Dr. Mericle said.
The program coordinates care through a central command center that operates 24/7. Physicians and advanced practice providers conduct telehealth visits while families use remote monitoring tools to transmit clinical data back to the care team.
That infrastructure allowed Nemours to expand the program beyond its original Florida launch site. The health system now serves families across the Delaware Valley — including Pennsylvania, Delaware, Maryland and New Jersey — in addition to Florida.
“Now we are in five states,” Dr. Mericle said. “Our command center is in our home office in Jacksonville, and it serves all of those states.”
As participation has grown, Nemours has begun to track how the program affects hospital utilization and patient outcomes. Leaders estimate the initiative has meaningfully reduced both inpatient days and emergency department use.
“We have trimmed more than 365 days of length of stay,” Dr. Mericle said. “We think we’ve avoided at least 185 ED visits.”
A large share of the program’s patients have complex medical conditions, a population that historically faces high rates of readmission. Dr. Mericle estimates the program has significantly reduced 30-day readmissions among those children.
About 75% of the children enrolled in the program have complex medical needs, and Nemours estimates the model has reduced 30-day same-cause hospital readmissions among those patients by roughly 67%.
The program also differs from many adult hospital-at-home models, which typically substitute for inpatient admissions. Nemours uses its program primarily to help children leave the hospital earlier or avoid admission entirely.
“We’re able to bring them home much sooner,” the executive said. “We’re also able to avoid admission because it may be that they’re identified in the ED or a clinic and we can avoid bringing them into the hospital altogether.”
Clinicians have used the program across a wide range of pediatric cases — from infants leaving neonatal ICUs who still need feeding support to adolescents recovering from surgery.
Despite its similarities to hospital-at-home programs for adults, Nemours’ model currently operates outside the CMS Acute Hospital Care at Home waiver. As a freestanding children’s hospital, Nemours does not qualify for the federal program.
However, Dr. Mericle said Nemours leaders are continuing discussions with other pediatric systems and policymakers about how federal hospital-at-home policies might eventually include children’s hospitals.
The health system is also expanding the program’s capabilities. Nemours is preparing to launch an in-home phototherapy pilot for newborns with high bilirubin levels, allowing some infants who would normally remain hospitalized for several days to receive treatment at home.
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