In recent years, hospital at home programs have become a compelling adjunct to traditional, inpatient hospital care. These programs can increase patient satisfaction, reduce healthcare costs, and improve outcomes by providing acute care services to patients in the comfort of their homes.
As an example, Brigham and Women’s Hospital, a leading academic medical center, found that its hospital at home program could decrease readmissions by 70% and achieve 38% cost savings while freeing up inpatient bed capacity and increasing patient mobility.1
To succeed with hospital at home programs, organizations must articulate a clear vision, overcome logistical hurdles, and gain buy-in from physicians. At a recent Hospital at Home Leadership Summit workshop, attendees discussed these challenges and best practices to overcome them. On gaining clinician buy-in, workshop participants discussed a shared experience around skeptical physicians. Following a positive experience with a hospital at home referral, some of the most skeptical physicians often became the biggest internal advocates for the remote care program. One participant shared the story of an initially resistant clinician who described a patient’s recovery as, “one of the most satisfying professional experiences of their 25-year career”.
Demonstrating the effectiveness of hospital at home programs
Having the explicit support of the chief medical officer is critical to the success of hospital at home programs. Still, workshop attendees said that strong clinical outcomes and high patient satisfaction scores are the two most essential ingredients in gaining and sustaining broader organizational support for hospital at home programs. One hospital increased adoption by giving physicians timely updates on each patient they admitted into the program. By communicating on patient outcomes, including quality data and patient experience, the physicians gained confidence in the program and referred more patients. Workshop participants reported that high patient satisfaction and improved clinical outcomes are critical in measuring and defining the success of their hospital at home initiatives.
While outcomes provide real world evidence of hospital at home benefits, sustaining support for programs takes ongoing, 1:1 engagement with clinicians - especially in the emergency department and trauma units. Due to a familiarity with technology, there may be an assumption that younger physicians will be early adopters of the hospital at home model. But it is important for health systems to suspend bias and cast a wide net across their providers. One workshop participant found that more tenured physicians were actually more amenable to accept the remote care at home model, while younger doctors hesitated due to liability and what-if concerns.
Many viable paths to implementing hospital at home
As healthcare systems pilot and scale their hospital at home programs, they are exploring different options to find the right mix of internal and outsourced resources for care delivery.
For instance, a 20-hospital health system, launching a hospital at home program this year, will use both employed and contracted hospitalists to staff their program. This will allow them to have adequate physican resources to initially grow the program. As a part of the plan, they are contracted to outsource mobile imaging, food services, and community paramedic roles. Their conclusion was that these services were more expensive to insource, at least at the launch of the program.
The question of how much of a hospital at home program should be insourced or outsourced is not binary. For clinical services, many health systems would prefer to insource 100 percent of care using their own registered nurses and physicians. However, the challenge is finding the internal resources to staff a new program. One participating system reported they initially recruited from their primary care divisions. Another health system insources all hospital at home services except for mobile imaging. They contract an external partner who captures and uploads images to the EMR for their internal radiologists to review. Other health systems combine virtual care from hospitalists with the in-home services of nurse practitioners, nurses, and mobile-integrated health paramedics.
Most health systems establish some type of “virtual command center” to centralize and support the 24/7 needs of patients in a hospital at home program. In addition to responding to patients’ needs, it’s critical to keep tabs on external vendors to ensure they meet the health system’s standards for quality and reliability. A workshop participant outlined a best practice of designating a hospital at home champion from relevant departments. Having this point person helps to streamline communication with virtual command center and more quickly troubleshoot issues as they arise
Attendees also expressed interest and shared examples of integrating social worker services into their programs. One system uses social workers to assess the home environment to ensure patients can safely receive services there. Another has seen success using a simple “social needs checklist” to screen patients and identify those who will be a good fit for hospital at home care delivery.
With the right engagement, organization, leadership, and technology, health systems are overcoming logistical and organizational obstacles to help their patient populations realize the full value of care at home.
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References:
- Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan