A Transformative Care Model
The Hospital at Home model makes acute hospital-level care available to adults and particularly older adults where they live, rather than in a traditional hospital setting. This alternative is needed because hospitals are not always the right environment for many patients. A substantial body of literature points to the hazards of hospitalization, notably for people 65+, including delirium, pneumonia, falls, polypharmacy, pressure sores, and infections. Persons 80 years and older and those with cognitive impairment are at particular risk for death during hospitalization. The COVID-19 pandemic raises additional challenges and dangers for these older patients as well.
While programs have been stood up in health systems in England, Canada, Israel, Australia and other countries, researchers at the Johns Hopkins Schools of Medicine and Public Health initially developed hospital at home in North America in the mid-1990s. During the last 25 years, hospital at home models have been broadly studied and tested. A wide range of research, including a 2012 meta-analysis of Hospital at Home programs, has demonstrated significant improvements in patients’ health, as well as lower costs. Additionally, in several surveys, patients and family members have rated the quality of Hospital at Home care as better than care provided in hospital.
While the model of care may vary, Hospital at Home programs provide patients with daily nursing visits and oversight by doctors and/or nurse practitioners. Providers are on call 24 hours a day/7 days a week. A typical Hospital at Home program includes a combination of in-person visits, video visits, and telehealth monitoring. Treatments such as oxygen therapy, intravenous fluids, and antibiotics can be administered through the program.
Hospital at Home programs may be configured in different ways in different systems and communities to creatively care for people in their homes. They may have different names, for example, Hospital in the Home or Home Hospital. Some programs are run out of the emergency department, offering patients with a defined set of diagnoses the option of being “admitted” into their homes, rather than the hospital. Other programs may use community paramedics, House Call programs, or clinics to refer patients.
The diversity of Hospital at Home programs highlights the commitment to innovation that is often necessary to implement these approaches. These variations also point to User Group members’ willingness to find solutions that are unique to their health systems, hospitals, and communities.