Becker's Hospital Review

26 Executive Briefing SPONSORED BY W esley, 74, is in the emergency room for the third time this year. His heart failure symptoms usually improve after a few days in the hospital, but he's not going to stay this time. He hates leaving his wife, Flora, who struggles with depression, alone at home. And during his last hospitalization, he experienced a frightening bout of confusion and believed intruders were stalking the halls. Now imagine Wesley's surprise when the physician suggests he be admitted — to his own bed at home. The physician explains the new hospital-at-home program to the family, who can barely believe their ears. Such an idea seems almost laughable! But Wesley definitely prefers to be at home with Flora and avoid the confusion and fear he experienced during his last visit. The hospital-at-home model is just one way healthcare is evolving to meet patient and cultural demands for better access, equity, and experience. For too long, patients have traveled to providers for care — often at significant cost to their families and quality of life. It's time to shift the paradigm so that providers meet patients where and when they need care. Or, as we say at Vituity, it's time to deliver "health in place." An Urgent Need for Change While our extant provider-centric paradigm has never been ideal for patients, the pandemic underscored its shortcomings. Many patients avoided healthcare settings during the initial lockdown. According to a survey by Harvard University, the Robert Wood Johnson Foundation, and National Public Radio, members of one in five U.S. households delayed or skipped care during this period. Over half of these individuals now report negative health consequences as a result. 1 In addition, the pandemic underscored shocking racial disparities in care quality and access. Black, Latino, and Indigenous patients contracted and died from COVID-19 at far higher rates than white patients. 2 These trends illuminate a long shadow of medical neglect and limited access that now demands action from healthcare leaders. And while the pandemic supercharged demand for patient- centric care, the need was always there. Wesley's case is an illustrative example. About a third of hospitalized patients over 65 experience delirium, impacting their future health and functioning. 3 Older inpatients also run the risks of hospital- acquired infections, functional decline, falls and pressure injuries. 4 And finally, hospitalization exacts a financial and social toll by keeping patients from work and family responsibilities (e.g., Wesley's separation from his wife). What's emerging is demand for new care models that meet patients where they are. It's time to extend care beyond the hospital walls — not only because recent events have exposed inequities in our system, but also because it's the right thing to do. To illustrate, let's examine hospital at home in more detail. Bringing the Hospital Home to Patients Hospital-at-home programs deliver an inpatient level of care to patients in the community via telehealth, remote monitoring, and mobile care teams. They're most appropriate for medium- acuity patients whose conditions have well-defined treatment protocols (e.g., COPD and CHF). Hospitals at home are common in Canada, Australia, Israel and the United Kingdom. A robust body of research shows they reduce costs while boosting outcomes and patient satisfaction. 5 However, until recently, this approach never gained traction in the U.S. due to cultural and reimbursement barriers. 6 Medicare has never recognized the home as a clinical site of care, and most states and private insurers have followed suit. Additionally, the hospital-at-home concept flies in the face of the provider-centric culture endemic to the U.S. This changed during the pandemic, when hospital-at-home programs became top of mind. In 2020, Vituity partnered with Adventist Health Central Valley Network to open a 150- bed hospital at home in one of California's most underserved regions. This program led to the adoption of the offering throughout the Adventist Health network. The Veterans Health Administration, Mayo Clinic, Kaiser Permanente and other leading health systems have also invested in this concept. Benefits to Patients, Providers, and Hospitals For patients, hospital at home represents quality of life. Given a choice, many of us would prefer to heal in the comfort of our homes with our loved ones nearby. Research shows hospital- at-home patients experience less delirium and receive fewer low-value lab and diagnostic tests. It's no wonder recipients and families rate these programs highly on patient experience surveys. 7 Like patients, clinicians also report high levels of satisfaction with hospital at home. Hospitalists at Adventist enjoy spending more time with each patient and even having opportunities to address social determinants of health. For example, during a telehealth visit, a hospitalist might notice fall hazards in the home or a caregiver struggling with burnout. By connecting families with needed social resources, clinicians can often achieve better, more sustainable health outcomes. Putting the Patient Front and Center in Care Delivery By Theo Koury, MD, President, Vituity

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