Hospital at home (or the next best thing)
Carolyn Sites, D.O.
Senior medical director, Providence Hospitalist Programs
April 17, 2013
"Hospital at home" is broadly understood to be an innovative and cost-effective way for patients with certain diagnoses to receive hospital services in their homes. Some programs integrate telemedicine and remote monitoring in addition to physician home visits.
A hospital at home, or H@H pilot, now underway at Providence Portland Medical Center, varies from this model. It emphasizes ready access to various levels of care at a skilled nursing facility and through Providence Home Services to patients who present in the ED with certain conditions. These may include pneumonia, urinary tract infections, cellulitis, nonsurgical fractures and mild exacerbation of COPD or chronic heart failure – diagnoses that are associated with hospital stays of less than three days.
The initiative’s goal is to redirect patients with short-term, acute-care needs to more appropriate and lower-cost care environments. Although this pilot does not include physician home visits, a rounding physician will see an H@H patient within 24 hours of admission to a skilled nursing facility. Depending on the need, a nurse, physical therapist or occupational therapist from Providence Home Services will see an H@H patient in his or her home within 24 hours.
The Providence Hospital at Home pilot is limited to patients with Providence Health Plan coverage and a current or prospective PMG primary care provider.
Helping with triage, transfer or discharge from the hospital are RN care managers, ED staff, hospitalists, long-term care or skilled nursing facility physicians, Providence Home Health Services and the administration of Marquis Care of Mt. Tabor, our pilot skilled nursing facility. Each has developed workflows that include communication with PMG outpatient physicians and case managers, ensuring appropriate follow-up care.
The pilot began in November and is expected to go through June. We’ll report results as soon as they become available.
Related: How home care is keeping one grateful patient out of the hospital