Hospital Home Care Research Articles

Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities.

The $1 trillion industry of acute hospital care in the United States is shifting from inside the walls of the hospital to patient homes. To tackle the limitations of current hospital care in the United States, on November 25, 2020, the Center for Medicare & Medicaid Services announced that the acute hospital care at home waiver would reimburse for “home hospital” services. A “home hospital” is the home‐based provision of acute services usually associated with the traditional inpatient hospital setting. Prior work suggests that home hospital care can reduce costs, maintain quality and safety, and improve patient experiences for select acutely ill adults who require hospital‐level care. However, most emergency physicians are unfamiliar with the evidence of benefits demonstrated by home hospital services, especially for older adults. Therefore, the lead author solicited narrative inputs on this topic from selected experts in emergency medicine and home hospital services with clinical experience, publications, and funding on home hospital care. Then we sought to identify information most relevant to the practice of emergency medicine. We outline the proven and potential benefits of home hospital services specific to older adults compared to traditional acute care hospitalization with a focus on the emergency department.

Acute Care Reimagined: Home Hospital Care Can Support the Triple Aim and Reduce Health Disparities.

Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.

Scoping and testing rural acute care at home: a simulation analysis

PurposeHospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered.MethodsBased on prior...

Predictors and Reasons Why Patients Decline to Participate in Home Hospital: a Mixed Methods Analysis of a Randomized Controlled Trial.

Acute care at home ("home hospital") compared to traditional hospital care has been shown to lower cost, utilization, and readmission and improve patient experience and physical activity. Despite these benefits, many patients decline to enroll in home hospital. Describe predictors and reasons why patients decline home hospital. Mixed methods evaluation of a randomized controlled trial. Patients in the emergency department who required admission and were accepted for home hospital by the home hospital attending, but ultimately declined to enroll. Home hospital care, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. We conducted a thematic content analysis of verbatim reasons for decline. We performed bivariate comparisons then multivariable logistic regression to identify patient characteristics associated with declining participation. Two hundred forty-eight patients were eligible to enroll, and 157 (63%) declined enrollment. Patients who declined and enrolled were of similar age (median age, 74 vs 75 years old; p = 0.27), sex (32% vs 36% female; p = 0.49), and race/ethnicity (p = 0.26). In multivariable analysis, patients were significantly more likely to decline if they initially presented at the community hospital compared to the academic medical center (53% vs 42%; adjusted OR, 2.2 [95% CI, 1.2 to 4.2]) and if single (37% v 24%; adjusted OR, 2.5 [95% CI, 1.2 to 5.1]). We formulated 10 qualitative categories describing reasons patients ultimately declined. Many patients declined because they felt it was easier to remain in the hospital (20%) or felt safer in the hospital than in their home (20%). Patients who declined to enroll in a home hospital intervention had similar sociodemographic characteristics as enrollees except partner status and declined most often for perceptions surrounding safety at home and the ease of remaining in the hospital. NCT03203759.

Rural Perceptions of Acute Care at Home: A Qualitative Analysis.

Hospital-level care at home in urban areas delivers low-cost, high-quality care. Few have attempted to deliver home hospital care in a rural environment, where traditional hospitals are often less equipped to deliver high-quality care. Little is known about rural clinicians' and patients' perceptions regarding rural home hospital care and how the urban model might be adapted to fit rural circumstances. We conducted semistructured qualitative interviews in the United States with a national purposive sample of practicing rural clinicians, a focus group with clinicians who care for rural patients, and interviews with rural patients. We coded these qualitative data into domains and subdomains. We identified 4 domains: (1) current state of rural health care, (2) attitudes toward rural home hospital, (3) perceived barriers to implementing rural home hospital, and (4) perceived facilitators to implementing rural home hospital. Participants expressed challenges with current rural health care, including inefficient care coupled with poor access. Most felt rural home hospital care could offer benefits, including comfort, timeliness, and downstream outcomes such as readmission rate reduction. Rural patients were open to receiving acute care in their homes. Potential barriers included geographic accessibility, Internet connectivity, rural hospital politics, the culture of hospitalization, and the availability of skilled human resources. Significant interest and optimism exist surrounding rural home hospital despite perceived barriers. Designing for and testing adaptations to the urban model will likely optimize benefits and minimize threats to a potential intervention.

COD19 and COD20: An Italian Experience of Active Home Surveillance in COVID-19 Patients.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic found Italy unprepared to cope with the large concentrated numbers of patients infected with coronavirus disease 2019 (COVID-19) who often required hospital admission and in many cases intensive care. This pandemic very quickly overwhelmed the Italian Healthcare System. This paper describes the Active Home Surveillance System (Operations Center for Discharged Patients; COD19) and the Home Hospital Care System (COD20) and presents the clinical data collected and the level of user satisfaction with the service. The Operations Center for Discharged Patients (COD19) is an active surveillance service for home-care patients which involves: (1) monitoring critical clinical conditions; (2) recognizing social and health issues; (3) and providing necessary clinical services in the form of a telemedicine service. COD20 is a patient-specialist video consultation service that allows to perform an assessment of clinical conditions and any need to visit; defining the priority of access to specialist outpatient visits in the presence or manageable with the new video consultation model. This service was immediately necessary during the COD19 monitoring. COD19 and COD20 are based on the Amazon Web Services Serverless certified platform. The COD19 and COD20 platform can be intrinsically utilized for future epidemic outbreaks; also those with non-respiratory transmission; and is sufficiently flexible to adapt to natural catastrophes.

Redes de apoio no cuidado domiciliar ao recém-nascido prematuro: um relato de experiência

Este é um relato de experiência de um caso como de mãe de um neonato prematuro e teve como objetivo relatar a experiência da visita domiciliar no âmbito da Atenção Primária à Saúde, ressaltando a importância das redes de apoio no cuidado ao recém-nascido prematuro. Realizado em uma cidade do interior do Estado de São Paulo no primeiro semestre de 2018, usou o Mapa Mínimo da Rede Pessoal Social. As visitas domiciliares possibilitaram fortalecimento do vínculo no binômio mãe-filho e identificação de uma rede pessoal social fragilizada, indicando também dois problemas emergentes: família em isolamento social e pouco empoderamento individual. Percebe-se uma rede média, pouco densa, homogênea, com predominância de vínculos sociais ausentes e/ou rompidos. Os resultados denotam a importância da visita domiciliar para a continuidade do cuidado hospital-domicílio, trazendo à reflexão a relevância das redes de apoio às famílias de recém-nascidos prematuros.

Hospitalización domiciliaria en un área rural, ¿una alternativa a la hospitalización tradicional?

Introducción: El servicio de hospitalización domiciliaria en el área rural es un servicio poco conocido en el resto del ámbito sanitario. Al mismo tiempo existe poca literatura al respecto por lo que con este estudio queremos estudiar las características clínicas, la estancia media y la tasa de reingresos de los pacientes que ingresan en hospitalización domiciliaria en comparación a los pacientes que ingresan en planta de medicina interna pertenecientes a un hospital comarcal de un área rural (Hospital de TresMares).Método: Estudio descriptivo comparativo retrospectivo que incluye un total de 200 pacientes (100 ingresados en hospitalización domiciliaria y 100 ingresados en planta) del hospital de TresMaresResultados: La complejidad de los pacientes que ingresan en planta es superior a los que ingresan en hospitalización domiciliaria requiriendo al mismo tiempo de mayor uso de recursos. La eficacia, entendida como tasa de reingreso, en hospitalización a domicilio es similar a la de los pacientes de la planta. Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural.Conclusiones: Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural.

The three-stage assessment to support hospital-home care coordination in Tshwane, South Africa.

BackgroundIn complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load.AimThis article presents the results of an applied research initiative to facilitate the coordination of patient care.SettingThe study took place at three hospitals in the sub-district 3 public health complex (Tshwane district).MethodUsing a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge.ResultsThe coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients’ varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients’ care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks.ConclusionEffective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.

Acute Pediatric Home Hospital Care

Pediatric inpatient hospitalization can be lifesaving; yet it also can be costly and fraught with nosocomial risks. As of 2014, health care–related injury, morbidity, disability, or death occurs to 1 in 50 hospitalized children in the United States.1 Some patients are admitted for common illnesses, yet their stay is prolonged by hospital-acquired infection, procedure-related complications, or other detrimental sequelae. As US hospital inpatient and observation units overflow with admissions, a new paradigm is needed to safely transition select lower-acuity cases to the patient’s home. Pediatric home health care in the United States now primarily serves patients with chronic medical needs and those transitioning from hospital to home. Yet a new model can emerge as technology advances whereby children with certain acute illnesses are “admitted home” from the emergency department or outpatient center, with daily direct visits by mobile hospitalists and nurses and telemedicine monitoring as needed. Hospital-comparable services at home could include supplemental oxygen, intravenous fluids or medications, nebulized medications, and select laboratory tests. Pilot programs can target uncomplicated cases of bronchiolitis, wheezing, pneumonia, dehydration, and cellulitis that otherwise would require observation or lower-acuity inpatient care. These 5 diagnoses alone constituted 20% of the ∼2 million US pediatric inpatient hospitalizations in 2012.2 If one-fourth of this cohort met “home hospital” inclusion criteria, 5% of pediatric hospitalizations, or 100 000 children nationwide, could benefit from … Address correspondence to Julia Pian, Harvard Medical School, Harvard University, 25 Shattuck St, Boston, MA 02115. E-mail: julia_pian{at}hms.harvard.edu

The Evolution and Devolution of Hospital Care

The Evolution and Devolution of Hospital Care

Community nutrition nurse specialist role: a service improvement.

This article describes the introduction of a community nutrition specialist nurse role in Buckinghamshire. The need for this role arose from issues experienced by the large but busy district nursing team (caseload of >300 patients per day) in home enteral feeding management and troubleshooting. The post holder was appointed to support community, hospital, dietitians and industry home care nurses with nutritional screening in the community and home enteral feeding, with a greater focus on the former. The post holder was involved in the development of a community version of MUST along with a care pathway and the design of a training programme to improve district nurses' knowledge and confidence in managing malnutrition in the community. The post holder is also involved providing patients personalised advice for managing malnutrition and in referrals to the community dietetics team. Such innovations in staffing are vital if the negative impact of malnutrition on patients and the health service is to be curtailed.

Knowledge and skill needs of home caregivers and their care burden perceptions

Research problem/aim: Family members are increasingly taking more responsibility for patient care. We were conducted this study to determine knowledge and skill needs of in-home caregivers and their care burden perceptions. Methods: The study was designed as descriptive study. The universe of this study included 350 patients who were registered in a Public Hospital Home Care Services Department by year of 2016 and the research sample consisted of 161 patients and patient relatives. Data was collected to use Patient and Caregiver Forms, Care Burden Scale, and Barthel Index. We were calculated the data with percentage, average, standard deviation, independent samples t test, Mann Whitney U, Kruskal Wallis tests. Finding: Total Care Burden Scale point is 41.32 ± 13.20, caregiver’s age, marital status, educational status, economic status, to get help about care and receiving care duration do not affect CBS points, female caregivers have less CBS points than male caregivers and this difference is statistically significant (p < 0.05), the least skill level part of caregivers are care and prevention of decubitus, patient handling with the proper method, pay attention to their own body mechanisms, wound care, vital measurements, genital care, stress management and constipation. Conclusion: Caregivers have in a low level of training about care and need knowledge and skills according to patient needs. Care burden of men is higher than women.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p < 0.01) and less often received consultations (0% vs. 27%; p = 0.04). Home patients were more physically active (median minutes, 209 vs. 78; p < 0.01), with a trend toward more sleep. No adverse events occurred in home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p < 0.01) lower, with trends toward less use of home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

Home hospital care reduces cost, maintains quality and safety

Home hospital care reduces cost, maintains quality and safety

The caregiver's commitment and its limits

The question of commitment and its limits can be envisaged from the point of view of supervision in healthcare institutions or in home hospital care. When the commitment appears to be frustrated in the healthcare relationship, it must be supported and its limits should be defined.

Influence of home care in hospital on the post-discharged quality life of preterm infants

Objective To explore the effect of home care in hospital on the improvement of the post-discharged quality of life in preterm infants. Methods Seventy-four preterm infants who were hospitalized in NICU of Kunming Children's Hospital from August of 2015 to July of 2016 were included and divided into the control group and the invention group at random. Thirty-seven preterm infants were included into each group. The preterm infants in the control group accepted the conventional treatment and nursing in hospital. Besides the conventional treatment and nursing, the parents of the preterm infants in the intervention group accepted the preterm infant nursing which simulated the home environment when the infants were in hospital. Using the follow-up investigation method, the weight increasing, the rate of re-visiting the doctor of the preterm infants in the two groups were observed when they were discharged. Results One month after discharge the weight increasing of the preterm infants in the intervention group was (0.987±0.231) kg, which was significantly higher compared to the control group (0.760±0.179) kg (t=15.22, P<0.05) . One month after discharge the rate of re-visiting the doctor in the intervention group was 1, which was significantly fewer compared to the control group (χ2=8.86, P<0.05) . Conclusions Home care in hospital increases the parents' ability of taking care of preterm infants effectively, improves the health level and the development of preterm infants in NICU when they were discharged. Key words: Infant, preterm; Quality of life; Home care in hospital

Children’s Hospital Home Care Goes the Extra Mile for International Patients

This article describes how one pediatric home care department, part of a large children’s hospital, provides culturally competent, linguistically appropriate, family-centered care to its international patients. Understanding that family and ethnic factors shape responses to illness and potential acceptance of American health care, health care organizations may need to adapt their care models to respect and integrate a family’s culture. Children’s Hospital of Philadelphia’s Home Care department executes a culturally congruent program that establishes trust, coordinates care, and goes the extra mile to promote best practices and optimal outcomes for its international patients. Success is supported by a health care system that provides a culturally sensitive environment, a full-spectrum language services program, and an interdisciplinary care team that collaboratively and safely transitions patients from hospital to home care or home country.

Evaluation of the Patients Registered to Samsun Education and Research Hospital Home Care Services Unit

Objectives: Home care services have started being served by the public level in 2010 in Samsun. In our study, we aimed to define the home care services and general profile of the registered patients to home care services units. Materials and Methods: The population of this descriptive study consists of individuals over the age of 16, registered to the home care services unit of Samsun Education and Research Hospital. Data were obtained from computer records. Results: 1995 patients have been reached since the home care services have started. 860 of these patients are still within home care services. The average age was 74.8±18.60 and 42.72% of participants were male, 57.38% female. 61.21% of the patients were bedridden. All of the patients had health insurance. The most common disease was cerebrovascular disease by 21.42%. The most frequently performed invasive procedure has been foley catheter. Conclusion: Socio-demographic and illness characteristics of persons in home care services are different from the population of individuals in society. Considering the increasing elder population, it would be appropriate to provide more comprehensive public health services including home care services as well.

How to care for homebound patients?

As a result of an ageing population, low birth rates and longer life expectancies in developed countries, there is an increasing worldwide prevalence of patients with functional decline, dependence and impairment of activities of daily living. The medical follow-up of these functionally dependent patients poses a challenge, especially in the traditional outpatient settings where transport of these patients to a clinic is required. Delivering care for these dependent patients in their own homes remains one of the better ways of providing optimal care for them. We describe two cases, one identified from the community and the other from a hospital setting, which necessitated the activation of home care for continued management of these patients. This article discusses how our current community and hospital home care resources can be used to care for homebound patients, and how we can overcome current limitations in delivery of home care in our healthcare system.