Hospital-at-home programs provide hospital-level acute care to patients in their homes, freeing up inpatient bed capacity and improving accessibility for acutely ill patients. The Ohio State University Wexner Medical Center launched its program earlier this year, which involved selecting the right patients, developing new clinical workflows, and collaborating with various stakeholders to ensure the program met all requirements. Hospital-at-home programs have been shown to prevent unnecessary ED visits and readmissions and help providers pinpoint care gaps and close them. Providers looking to establish hospital-at-home services must be flexible and agile during the implementation process.
Hospital-at-home programs have become increasingly popular in recent years, particularly amid the COVID-19 pandemic, as virtual care technologies have made healthcare more available outside the four walls of the hospital. This model of care provides hospital-level acute care to patients in their homes, freeing up inpatient bed capacity and improving accessibility for acutely ill patients.
The Ohio State University Wexner Medical Center (OSU Wexner) is one of the healthcare providers offering hospital-at-home programs. The health system launched its program in January 2021 and is the first health system in central Ohio to be approved for the Centers for Medicare and Medicaid Services (CMS) Acute Hospital Care at Home initiative.
The program involves selecting the right patients, who are reviewed based on their medical charts, and their consent is obtained before they are transported home. The in-home care team then conducts an initial visit with the patient, and patients receive at least two in-home visits by care team members daily and a remote visit with a physician. Patients can also connect with their care team through a 24/7 command center. Remote patient monitoring (RPM) technology is supplied to patients and automatically connects to the command center, transmitting relevant data. Following discharge from the hospital-at-home program, patients receive 15 more days of home-based transitional care.
The implementation of the hospital-at-home program was a collaborative effort involving individuals from more than 30 departments. New clinical workflows were developed for in-home care delivery, which included workflows for identifying and moving patients home, providing in-home care and ancillary services, and moving patients back to the hospital if their medical needs escalated. Developing these workflows involved an open dialogue among various stakeholders, as the workflows needed for hospital-at-home care could deviate significantly from those used in hospitals. The key stakeholders decided on at-home care processes that worked for all involved, and simulations and tabletop demonstrations were hosted to refine workflows and develop mitigation strategies.
One of the more complex workflows to develop was pharmacy services, which was due to state regulations. The hospital worked closely with the Ohio Board of Pharmacy to ensure the program met all requirements. Other implementation challenges included provider engagement and technology workflows, which were addressed by providing education on the program and its benefits to clinicians and working closely with IT to ensure the technology infrastructure could support this type of care delivery.
Previous research has been largely supportive of hospital-at-home models. Patients in hospital-at-home programs had a similar mortality risk, a 26 percent lower readmission risk, and a lower risk for admission into a long-term care facility compared with their in-hospital counterparts. However, hospital-at-home program participants had an average length of treatment that was 5.4 days longer than in-hospital patients. Though OSU Wexner has yet to research its program, it has been well-received among patients, who are excited about the prospect of getting home early.
Hospital-at-home programs provide several benefits, including freeing up inpatient bed capacity, improving accessibility for acutely ill patients, preventing unnecessary ED visits and readmissions, and helping providers pinpoint care gaps and close them. However, providers looking to establish hospital-at-home services must develop a rigorous process to identify eligible patients, maintain the same level of expectations for hospital-at-home quality and safety, and be flexible and agile as they go through the implementation process.
