It is estimated that currently about 10,000 people turn 65 years old every day. Even without pandemics, the chronic diseases of this aging population beg for new, innovative interventions. One trend that may be a significant offshoot of the 2020 focus on internet health care is hospital health care in the home. Light years ahead of the general practitioners house calls, some hospital have been working on this model prepandemic. And it is a good thing they had, as in 2020 and 2021, hospital beds were often scarce and patients needed significant monitoring beyond their hospital stays.
One such intervention being piloted now is called Advanced Care at Home (ACH). This is the name Mayo Clinic gave to the pilot, but both Mayo Clinic and Kaiser Permanente are working on this concept (and likely more will follow). Currently, the Mayo Clinics in Jacksonville, FL, and Eau Claire, WI, have begun the project, with others to follow.
Two questions they asked their leaders were as follows:
1. Is it possible to provide high-quality acute care outside of a hospital building?
2. Can the health care team go to the patient's location?
They believed the answers were "yes." The choice of patients required careful selection. Diagnoses included cellulitis, disorders of nutrition and metabolism, COPD (chronic obstructive pulmonary disease), CHF (congestive heart failure), migraines and headaches, gastroenteritis, bronchitis and asthma, and respiratory failure with infection or inflammation.
Once a patient is "admitted" into the program, the following may occur ("Home Sweet Home," 2021):
* The patients are loaned a tailored technology package, including an iPad, Wi-Fi phone, Bluetooth vital sign monitoring equipment, and (as needed) intravenous (IV) equipment, wound care supplies, home oxygen, etc. All needed supplies/technology are delivered to the patient's home, usually by paramedics or an emergency medical team.
* The patient is transported home via ambulance.
* Advanced care providers visit the patient at home. This may include nurses, paramedics, physical therapists, phlebotomists, respiratory therapists, home health aides, and infusion therapists. Medications, durable medical equipment, and medical meals are brought in. Medicare waste is retrieved; laboratory test, imaging, and IV therapies are provided in the home.
* There is a Command Center with the hospital where physicians will direct the patient's care with daily telemedicine rounds, typically when a nurse practitioner or physician is present at the bedside. This is the acute phase. During the restorative phase, an advance practice provider may manage the care.
* Nurse check in the patient when it is time to take medications and check vital signs.
* Patients have immediate video and phone access to the health care team. Real-time remote monitoring 24 hr a day is provided. Patients and families can contact the Command Center at the touch of a button.
* Should the patient's health deteriorate, emergency medical personnel are immediately dispatched to the home.
Will this decrease readmissions? Will it increase patient satisfaction and sustain the patient's independence? Intuitively, I believe so. Many of the baby boomers are fiercely independent. When even a fall with a wrist fracture can start a downward spiral of fear of losing one's independence, imagine what chronic conditions may mean. This flips the whole hospitalization concept on its head!
Many unknowns must be considered, some even as basic as the nursing shortage. Leverages with home health agencies will be considered.
As you can imagine, case managers will play important roles in this, from evaluating candidates who may find meaningful and successful outcomes in this type of care to our business as normal-orchestrating the players, including insurance, durable medical equipment, as a communication synapse to all the health care personnel, and managing the transition in and out of ACH (which typically lasts 1 month), to name a few. In fact, I see the case manager in the Command Center, doing what we always do best.
Reference