Most COVID-19 patients that received care through a hospital-at-home program did not require care escalation to a brick-and-mortar hospital setting, new research suggests.
The new findings on care escalation risk factors were published on Tuesday in the Annals of Internal Medicine. To explore the topic, Atrium Health researchers examined 391 patients receiving treatment for COVID-19 in the health system’s hospital-at-home program between March and November 2020.
As a response to the COVID-19 emergency, many health care organizations have launched hospital-at-home initiatives or similar programs in an attempt to remove the burden on hospitals. Atrium Health Hospital at Home was among these health care organizations.
In general, hospital-at-home programs attempt to provide acute, hospital-level care in the home as an alternative to hospital admission. To do so, programs try to identify eligible patients whose medical conditions can be cared for in the home setting through coordinated nursing and clinician visits, plus necessary testing and treatment.
The patients eligible for Atrium Health Hospital at Home were individuals who would have been admitted into a traditional hospital facility. These were patients who had safe living conditions and were clinically stable, according to the study.
“[Atrium Health Hospital at Home] care included 24/7 telephonic access to nurses; at least daily in-home visits from paramedics; daily virtual visits with a hospitalist; and therapies that included intravenous fluids and antibiotics, noninvasive oxygen, and respiratory medications as needed,” the researchers wrote in the Annals of Internal Medicine. “We examined patients admitted from ambulatory care, emergency departments, or community settings to [Atrium Health Hospital at Home] within 14 days of an initial positive result on a COVID-19 test.”
Overall, researchers found that the hospital-at-home patients did not need to be transferred to a traditional hospital setting. In fact, only one in five patients were admitted into the hospital within 14 days.
“Home-based hospital care is an attractive innovation that may extend critical hospital resources during the COVID-19 pandemic,” the researchers continued.
Broadly, the patients that needed immediate care escalation were those who faced more severe respiratory challenges.
One major takeaway from the study is that hospital-at-home is a safe and effective care delivery model for appropriately selected patients, according to Shih-Hsiung Chou, the study’s corresponding author.
“Atrium Health will continue to intentionally and thoughtfully grow the [hospital-at-home] program and its supporting evidence so that it becomes a widely accessible, patient-centric, affordable care option for our patients,” he told Home Health Care News in an email.
The information is vital at a time when the COVID-19 emergency has emphasized the importance of decentralizing the way that care is delivered. Plus, the hospital-at-home model falls in line with the growing preference for home-based care as an alternative to institutional settings.
Along those lines, the U.S. Centers for Medicare & Medicaid Services (CMS) introduced its “Acute Hospital Care At Home” wavier program in November.
The wavier program was a COVID-19 relief measure from CMS that fueled the growth of hospital-at-home across the U.S. It allowed hospitals already working in the space, as well as those looking to enter for the first time to be compensated for delivering care.
Prior to the creation of CMS’s program, reimbursement was a major pain point for health care organizations working in the hospital-at-home space.
As of April, 56 health systems and 127 hospitals, in total, across 29 states have been accepted as participants in CMS’s hospital-at-home initiative.