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33 PATIENT SAFETY AND OUTCOMES Hospital at Home 'cheat sheet': 6 Qs on the care model, answered By Mackenzie Bean I f "Hospital at Home," is a term you've been hearing more oen, you're not alone. e term was coined more than two decades ago, but has gained popularity in the last year as hospitals look to innovative care-delivery models to preserve bed capacity and limit COVID-19 exposure risks during the pandemic. Below is a breakdown on what the Hospital at Home care model entails, how it originated, which health systems have mastered it and more. What is it? e model entails providing hospital-level care to acutely ill older adults in the comfort of their own homes with the goal of fully substituting acute hospital care, according to Baltimore-based Johns Hopkins Medicine. What are its origins? e Hospital at Home model dates to 1995 and is the brainchild of John Burton, MD, former director of geriatric medicine and gerontology at Johns Hopkins School of Medicine in Baltimore, and Donna Regenstreif, PhD, a former leader at the John A. Hartford Foundation, a nonprofit organization dedicated to improving care of older adults. Drs. Burton and Regenstreif envisioned a model to provide safe and effective hospital care at home. A team of geriatric researchers led by Bruce Leff, MD, a professor of medicine at Johns Hopkins, developed the basic clinical model and its patient eligibility criteria. From 1996 to 1998, the researchers conducted a 17-patient pilot trial to prove the model's safety and feasibility, followed by a national study at three Medicare managed care organizations and one Veterans Affairs hospital from 2000 to 2002 to further assess its safety and benefits. e latter effort marked the first time the model was fully implemented as a replacement for hospital care, according to Johns Hopkins. In 2011, Johns Hopkins helped the healthcare startup Clinically Home develop its own home-based care model, which relies more heavily on telemedicine than the original model. How does the model work? In Johns Hopkins' model, the process starts with healthcare staff identifying eligible patients using validated criteria. is step oen occurs in the emergency department or ambulatory care sites. Patients who are eligible and agree to participate are evaluated by the physician who will oversee their home-based care and are then transported home, oen by ambulance. e patient will receive extended nursing care during the initial por- tion of their "admission," which then tapers off to daily nursing visits based on clinical need. A physician will also visit the patient daily for an evaluation and will implement any necessary diagnostic measures or treatments at home. Such measures include electrocardiograms, echocardiograms, X-rays, oxygen therapy and intravenous fluids or antibiotics. For some procedures like MRIs and endoscopies, patients will need to make a brief trip to the hospital. In the Clinically Home model, physicians perform video visits with the patient and nursing staff, instead of doing house calls, according to an article from e Commonwealth Fund, a healthcare policy research firm. is care process continues until the patient is stable, and at the time of discharge, care reverts to the patient's primary care physician. What are the model's benefits? Over the last two decades, mounting evidence has pointed to the model's clinical and financial benefits for patients and healthcare organizations. Johns Hopkins' first national study of the model, which was pub- lished in Annals of Internal Medicine in 2005, found patients treated via the Hospital at Home model had: • Better clinical outcomes • A shorter average length of stay (3.2 days versus 4.9 days) • Higher patient and family satisfaction • Fewer lab and diagnostic tests compared to similar hospitalized patients • Fewer complications oen associated with hospital stays, such as delirium, infections and the need for sedative medications or physical restraints • Lower care costs by up to 30 percent compared to traditional inpatient care Many patients are attracted to the convenience and comfort of re- ceiving care in their own homes. e model also allows caregivers or family members to remain at the patient's bedside, which is not always possible in hospitals today due to COVID-19 visitor restrictions. For hospitals, the model can translate into greater cost-savings and more clinical efficiency. e model also offers unique benefits during Many patients are attracted to the convenience and comfort of receiving care in their own homes. The model also allows caregivers or family mem- bers to remain at the patient's bed- side, which is not always possible in hospitals today due to COVID-19 visitor restrictions.