Health & Medicine - Posted by John Lazarou-JHU on Thursday, June 7, 2012 12:29 - 2 Comments
‘Hospital at Home’ saves cash, cures patients
JOHNS HOPKINS (US) — Sending doctors and nurses on daily house calls to provide hospital-level care reduced costs by 19 percent in a recent test and produced outcomes at least as good as those for hospital inpatients.
The test of “Hospital at Home” by a New Mexico health system demonstrated that such programs can work with “dramatic positive clinical and economic outcomes for patients and systems,” says Bruce Leff, a professor at Johns Hopkins University who developed the model.
Leff, leader of a study published in the June issue of the journal Health Affairs, says the program puts into practice “what health care reform is attempting to achieve. It’s a high-quality clinical program that provides patient-centric individualized care while making the most effective and efficient use of the health-care dollar.”
Straight from the Source
The yearlong study involved 323 patients, sick enough to require hospitalization, who opted instead for Hospital at Home. Researchers compared those patients with 1,048 hospital inpatients. In both groups, patients were elderly, mostly female, and white.
All Hospital at Home patients in the study met eligibility criteria to ensure patient safety and all lived within a 25-mile radius of an emergency department run by Presbyterian Healthcare Services of Albuquerque.
Physicians visited each patient daily for medical care, diagnosis, and care plan coordination. Depending on the patient’s condition, nurses would visit once or twice daily to assess the patient and administer infusions and other medications, conduct routine lab tests, perform ordered care procedures, teach patients and their families about managing their medical conditions, and prepare them for eventual discharge.
The patients in the study had a variety of health problems, including recurring congestive heart failure, cellulitis, deep vein thrombosis, pulmonary embolism, urinary tract infection, nausea, vomiting, and dehydration. The most common diagnosis was pneumonia.
Among the study’s key findings was that Hospital at Home patients had slightly lower hospital readmission and mortality rates, and almost 10 percent higher satisfaction scores than comparable patients. Presbyterian also had lower patient costs that resulted from shorter patient hospital stays and the use of fewer lab and diagnostic tests compared with patients in hospital acute care.
“The model allows physicians to provide patient-centered, evidence-based care,” says Melanie Van Amsterdam, lead physician for Presbyterian’s Hospital at Home program. “I am able to spend more time with my patients, helping them and treating their illnesses.”
Despite the success of the Hospital at Home program, Leff says, implementation of the program on a wide scale has been limited by the incorrect assumption that hospital care is safer and by payment issues with Medicare.
There are no payment codes for Hospital at Home-type care in fee-for-service Medicare. Thus, implementation of the Hospital at Home model has been limited to Medicare-managed care programs and Veterans Affairs health systems.
Along with Leff and Van Amsterdam, Leslie Cryer, executive director of Presbyterian Home Healthcare, and Scott B. Shannon, director of finance and business informatics for Presbyterian Home Healthcare, also worked on the study.
Leff was supported by a grant from the John A. Hartford Foundation. Leff is president of the American Academy of Home Care Physicians (uncompensated). Under agreements between The Johns Hopkins University and Mobile Doctors 24/7 International, the university is entitled to fees for licensing and consulting services related to the Hospital at Home care model.
Under institutional consulting agreements between Johns Hopkins University, Johns Hopkins Health System, and Clinically Home, the university and health system were entitled to fees for consulting services related to the Hospital at Home care model until March 2012, when that relationship was terminated. The terms of the above arrangements are managed by Johns Hopkins University in accordance with its conflict-of-interest policies. Hospital at Home is a registered U.S. service mark.
More news from Johns Hopkins University: http://releases.jhu.edu/