Abstract

BackgroundHealthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively)AimIn a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction.ResultsWe tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record.ConclusionThe current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Highlights

  • In 2012, the Netherlands Society of Cardiology (NVVC) started a robust programme, NVVC Connect, to stimulate seamless care between hospital and primary care by connecting cardiologists with general practitioners and other primary care providers [1]

  • The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets

  • Ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients

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Summary

Introduction

In 2012, the Netherlands Society of Cardiology (NVVC) started a robust programme, NVVC Connect, to stimulate seamless care between hospital and primary care by connecting cardiologists with general practitioners and other primary care providers [1]. The main aim of this programme was to safely and expeditiously provide guideline-driven care for patients through optimal alignment of all the caregivers involved. In 2018, the Dutch government set up a task force, Juiste Zorg op de Juiste Plek (Right Care in the Right Place), which developed a programme to relocate care, facilitate the use of e-health applications and prevent more expensive care [2]. This programme provides tools to support caregivers in building transmural networks allowing hospital care to be transformed into treatment at home. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction

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