Hospital@Home: a proof of concept

Abstract

Abstract Background Expenditure in healthcare in the Netherlands is so increasing that currently 1 in 7 employees are working in the health care/cure. Future expansion is under constrain given the 10% of GDP use and shortage of working force.Dutch healthcare consists of a cure section (mostly hospitals) and nursing care@home. Both entities have different national budgets (€25 + €20bln) Methods In a proof of concept, we explored a new Hospital@Home (H@H) model combining hospital cure and home-care budgets in a 800 mi2 district with 850,000 inhabitants. The objective comprises 4 proofs: (1)provide hospital care@home, (2) combine financial budgets (3) increasing working forces by combining teams, (4) increased satisfaction of pts and nursing staff. Results We proofed a joining budgets of the hospital and home-care group for cardiology. The homecare-budget was sufficient to hire 3 nurse practitioners who are trained by the cardiologists and work with 16 home-care cardiovascular nurses for H@H treatment. The hospital budget provided a virtual EHR cardiology ward and supplied the home care-nurses with a nursing app to assess the patients EHR. Budgets were sufficient to obtain the home-heartfailure monitoring application. The cardiology-group developed the H@H program for endocarditis treatment and heartfailure telemonitoring. Clinically, in the first 6 months, 50% of hospitalized endocarditis pts were treated with iv antibiotics@home with an average 16.5 days per pt shorter admission days without complications. 33% of eligible hospitalized heartfailure pts consented for telemonitoring@home while up-titrated on medication. Video-consulting reduced outpatient visits with 75%. Patient satisfaction was 75/100. Conclusion In this proof of concept, the H@H program provided hospital cure at home by merging hospital and home-care nursing staff and ICT budgets. Patient satisfaction score were driven by shorter admissions and less hospital visits. We call for further exploration of efforts to facilitate combined home-care and hospital-cure transmural budgets to confirm this proof of concept. Funding Acknowledgement Type of funding source: None