Lessons from Cleveland Clinic's 1st year of 'hospital at home'

Cleveland Clinic's hospital-at-home initiative has patient experience scores that rival any of the health system's inpatient units, the program's leader told Becker's.

Cleveland Clinic launched acute hospital care at home in April 2023, and is now treating about 200 to 250 patients a month. The program is live at four hospitals in the health system's Florida market, caring for about 1,000 people in the first year.

"The patients have loved the care model," Richard Rothman, MD, chief medical operations officer of Cleveland Clinic Florida, told Becker's. "The patient experience scores are amongst the highest patient experience scores we've seen in any of our inpatient wards across the Cleveland Clinic."

Cleveland Clinic has taken a deliberate approach to rolling out "hospital at home" to ensure patient safety is on par with the hospital. Dr. Rothman compares the care model to where electric cars were about a decade ago.

"It took time where the electric car industry really had to prove that they had a better product that was safer and more sustainable," he said.

The Cleveland Clinic nurses who support the program virtually have been reporting high levels of satisfaction as well. "It's refreshing to see that," Dr. Rothman said. "Nurses today in the command center … are actually walking on treadmills under their desks, they're smiling, they're interacting with their patients. They come to work and they want to be there."

He said his health system's program is unique in that it only treats acutely hospitalized inpatients, admitting about 65% of them directly from the emergency department. The average daily census is 22 patients.

Culture change remains a work in progress. "We underappreciated the distrust of the new care model that we would encounter among our frontline caregivers, hospitals, consultants and other ancillary staff," he said. "Hospital-level care has been ingrained in our culture since the 1600s. And so imagine now 400 years later, when you're sick and you need to be hospitalized, you can now be at home. And that change takes time, both for the patients and for the providers." 

That's why having robust data on outcomes will be so important, Dr. Rothman said.

Cleveland Clinic may expand "hospital at home" to Ohio but believed the program could make the most difference in its Florida market, which struggles with capacity issues and demographic challenges.

The health system opened a 24-7 virtual command center in Vero Beach, Fla., in December, staffed by hospitalists, nurses and pharmacists who manage the hospital-at-home patients remotely. Cleveland Clinic contracts with community healthcare providers that supply the in-home nurses, paramedics and other clinicians.

Cleveland Clinic's ultimate goal is to have 10% of its inpatient admissions treated at home. The health system plans to double the size of the program in the next year.

"Our goal is to continue to grow safely," Dr. Rothman said. "Sustainability of the care delivery model is really going to be dictated by whether outcomes are better, if individuals providing the care are enjoying the work that they're doing, and if we're able to do it at a cost that's comparable or less than the hospital."

He added: "We think this will be a model that will have sustainability."

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