1. HOME HOSPITAL By Patrick Whitledge PA-S2

2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort of their own homes.

3. INTRODUCTION Developed by the Johns Hopkins Schools of Medicine and Public Health and tested at medical centers across the country, this innovative care model lowers costs by nearly one-third, and reduces complications.

4. How it Works? A patient requiring admission for one of the “target illnesses” is identified in the local Emergency Department. Staff assesses if the patient is a good candidate for the program using validated criteria.

5. Appropriate Candidates Who are appropriate candidates? Patients with (target) illnesses including community- acquired pneumonia, congestive heart failure, chronic obstructive pulmonary disease (emphysema), cellulitis, volume depletions / dehydration, urinary tract infection / urosepsis, deep venous thrombosis and pulmonary embolism, are consider good candidates for home hospital. Usually patients will be 65 and older

6. Appropriate Candidates A study was performed by John Hopkins Bayview Medical Center titled: Prospective evaluation of clinical criteria to select older persons with acute medical illness for care in a hypothetical home hospital. This study define criteria that can identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital. The study looked at around 150 charts and a comprehensive medical team determined that around 33% of the patients could have been managed with a home hospital model.

7. How it Works? If ER staff finds the patient to be eligible the patient must then consent to participate in the Home Hospital model. After that a Hospital at Home physician evaluates the patient. The patient is then transported home, usually by ambulance.

8. How it Works? Once home, the patient receives extended nursing care for the initial portion of their admission, and then at least daily nursing visits according to clinical need. Nurses are available 24 hours a day/7 days a week for any urgent or emergent situation.

9. How it Works? The patient is evaluated daily by the Home Hospital physician who completes an assessment and continues to implement appropriate diagnostic and therapeutic measures. The physician makes one or more home visits per day and is available 24 hours a day/7 days a week for any urgent or emergent situation.

10. How it Works? The patient can receive diagnostic studies such as electrocardiograms, echocardiograms, and x-rays at home, as well as treatments, including oxygen therapy, intravenous fluids, intravenous antibiotics, and other medicines, respiratory therapy, pharmacy services, and skilled nursing services. Diagnostic studies and therapeutics that cannot be provided at home, such as computerized tomography, magnetic resonance imaging, or endoscopy, are available via brief visits to the acute hospital.

11. How it Works? Once treatment is complete the patient is discharged from the home hospital’s physician and is instructed to follow up with their primary care physician.

12. Why? When compared to traditional hospital stays, studies show that home hospital patients are less likely to experience complications such as delirium and are less likely to require sedative type medications or restraints. Family also has greater access to the patient and reports feeling less stress during the course of care.

13. Why? In quality insurance studies both patients and family report a greater level of satisfaction with the home hospital model then a traditional hospital stay. Overall cost have been shown to be 60% less then traditional hospital stays.

14. History The concept was created in 1995 by Dr. John Burton, of Johns Hopkins School of Medicine, and Dr. Donna Regenstreif of The John A Hartford Foundation A geriatric study team led by Dr. Bruce Leff developed medical eligibility criteria and the basic clinical model and designed the study and measurement methodology. (the article previously discussed)

15. History In 1996 a 17 patient pilot trail was performed to ensure the method was feasible and safe: http://www.hospitalathome.org/files/Pilot.pdf http://www.hospitalathome.org/files/Pilot.pdf The result was that all 17 patients were safely treated and the cost to the patient was 60% less then a traditional hospital stay.

16. History In 2010 A public/private partnership tested a modified model of Home Hospital, in which home-based care is provided by nurses, with physician consult via biometrically enhanced two-way telemedicine-video. The new model is also managed by a physician group, instead of a hospital.

17. Current Programs Presbyterian Health Services, Albuquerque, New Mexico Veterans Affairs Medical Center, Boise, Idaho Veterans Affairs Medical Center, Honolulu, Hawaii Veterans Affairs Medical Center, New Orleans, Louisiana Veterans Affairs Medical Center, Philadelphia, Pennsylvania Veterans Affairs Medical Center, Portland, Oregon Veterans Affairs Medical Center, Bend, Oregon

18. Review

19. Not Convinced ?