Becker's Clinical Quality & Infection Control

34 PATIENT SAFETY AND OUTCOMES the pandemic, including conservation of personal protective equipment, greater bed availability and the ability to keep infectious patients out of the hospital. What systems have mastered it? New York City-based Mount Sinai Health System and Albuquerque, N.M.-based Presbyterian Healthcare Services were both early adopters of Johns Hopkins' Hospital at Home model. Presbyterian Healthcare Services launched its program in 2008. More than 92 percent of patients presented with the option for at-home care take it, according to a 2016 case study of the organization's program. In 2012, Presbyterian researchers published a study showing Medicare Advantage or Medicaid patients treated through the program had 19 percent lower care costs, along with similar or better outcomes than hospitalized patients. Mount Sinai launched its program in 2014 aer receiving a $9.6 million grant from the CMS Innovation Center. e health system found patients participating in its Hospitalization at Home program had an 8.6 percent 30-day readmission rate, compared to 16.1 percent for similar hospitalized patients, according to a case study from the American Hospital Association. Patients who received home-based care also had fewer ED visits (5.8 percent versus 11.9 percent) and reported a better patient experience (67.8 percent versus 45.6 percent). West Des Moines, Iowa-based UnityPoint Health is yet another health system that's found success with the model, which it adopted in 2018. e health system owns all the services provided under its model, which streamlines operations and allows the organization to get a patient home from the ED within two hours. In 2020, Unity- Point Health lowered its 30-day ED readmission rate for patients in the Hospital at Home program from 27 percent to 4 percent, achieved a 98.9 percent patient satis- faction score and saw an estimated cost reduction of more than $6,000 per patient, according to data shared with Becker's. Other prominent systems are also jumping on the bandwagon. In June 2020, Roch- ester, Minn.-based Mayo Clinic and Salt Lake City-based Intermountain Healthcare both rolled out their own models to deliver hospital care at home. In November 2020, CMS launched its Acute Hospital Care at Home program, which allowed hospitals to receive Medicare reimbursement for at-home care services pro- vided to patients for more than 60 conditions. As of April 5, more than 100 healthcare organizations were approved to participate in this program. Is your health system ready to implement a Hospital at Home program? Before adopting a home-based care model, health systems must ensure they have the necessary resources, roles, organizational culture and reimbursement models in place. Johns Hopkins outlines six questions health systems should ask before implementing such a model: • Is your health system experiencing problems from a lack of hospital capacity? • Does your health system have established home healthcare delivery capabilities? • Do you have physicians with the interest and ability to care for patients in the home environment? • Does your health system experience a large volume of Medicare admissions for common problems such as community-acquired pneumonia, heart failure or chronic pulmonary disease? • Does your institution view itself as an innovator in developing and implement- ing new models or systems of care? • Can your health system align payment, providers and the hospital for this model? n Study: Death risk higher even for COVID-19 survivors with mild cases By Mackenzie Bean S COVID-19 survivors who were not hospitalized still had a higher risk of death and required more healthcare services within six months than people without the virus, accord- ing to a study accepted for publication in Nature. Researchers analyzed medical re- cords of more than 73,000 Veterans Affairs patients nationwide who tested positive for COVID-19 between March 2002 and November 2020 but were not hospitalized. They compared their outcomes to those of nearly 5 million VA patients who did not have COVID-19 and were not hospitalized over the same period. Researchers found the death risk for COVID-19 survivors was 60 percent higher than people who had not contracted the virus one to six months after infection. COVID-19 survivors were also 20 percent more likely to need outpatient medical care within six months, reported The New York Times. Survivors often developed long-term health issues that affected various parts of the body, including nervous system disorders, gastrointestinal disorders and heart issues, researchers found. These individuals were also at greater risk for mental health issues and were more likely to take therapeutics like pain medications, antidepressants and blood pressure drugs. "The results provide a road map to inform health system planning and development of multidisciplinary care strategies to reduce chronic health loss among COVID-19 survivors," researchers concluded. n

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