Ohio Hospital Implements Community Healthcare Program

The Columbus Dispatch, Ohio

Aug. 13—When a persistent cough recently took James Conrad to the emergency department at Mount Carmel East hospital, doctors discovered fluid in his lungs.

But instead of admitting him, they asked if he'd rather be treated at his Johnstown home as part of a "Hospital at Home" program piloted by the health system this spring.

Conrad was taken home via ambulance. A nurse arrived within a half-hour, measured his vital signs and sent results to the hospital. During the four July days he was in the program, nurses stopped by twice a day, drawing blood, taking X-rays and providing him with needed medication. A doctor "visited" on a monitor via an internet connection, much like FaceTime or Skype.

Conrad is one of six patients who have participated in Mount Carmel's Hospital at Home initiative, which seeks to serve 40 patients through a $500,000 Trinity Health Innovation Challenge grant.

The model is "the future of health care," said Laura McQuithy, clinical manager of Mount Carmel Home Care, stressing that home is where people want to be when they are sick and recuperating.

"A home environment has a very positive impact on the patient and their whole family," she said. "It eases anxiety and stress, and it empowers the patient to be more in control of their health care."

The initiative is reserved for patients 65 or older who have specific diagnoses: certain skin infections; congestive heart failure resulting in fluid in the lungs; pneumonia; and other certain lung conditions, such as emphysema or bronchitis.

"Obviously, we don't want to do harm," said Dr. Daniel Wendorff, president and medical director of Mount Carmel Health Partners. "We want to make sure we're putting the right patients in this program so they receive the benefit of the program without any risk."

For example, he said, a patient with diabetes who develops a common skin infection on the legs would generally be hospitalized for treatment with intravenous antibiotics. Through Hospital at Home, that patient can go home with visits by a home-infusion company and Mount Carmel Home Care staff members, who are on hand to provide oxygen, IV medications and other needs.

A home-care visit might last as many as three hours, with a nurse using a tablet for a "face-to-face" call with a doctor to help assess the patient, McQuithy said. Most at-home stays last three to five days, and nurses typically visit multiple times a day.

Further, patients, through the touch of a computer tablet button, have 24/7 access to nursing-staff members who can contact doctors if needed.

The Hospital at Home model was conceived in 1995 by doctors at Johns Hopkins University School of Medicine and the John A. Hartford Foundation.

It is ideal for elderly patients who might refuse to go to the hospital even when seriously ill, and it can cut down on harsh, hospital-related complications that affect older people, particularly those who are frail, aid Dr. Bruce Leff, who led the team that developed and tested the model. Evidence points to fewer complications, lower costs and higher quality, Leff said.

Hospital at Home can be found in the U.S. in about 20 to 30 health systems and federal Veterans Affairs centers, and Leff said interest has grown exponentially over the past few years.

"As the U.S. health system moves toward value-based care and tries to move care out into the community, Hospital at Home will definitely be a component of that," said Leff, who specializes in geriatrics at Johns Hopkins.

Wendorff said patients have provided positive feedback on care and convenience—one patient avoided the task of finding dog care, and another went to a karaoke event on the final day of in-home care.

Further, Wendorff said, the program saves money, with the total cost of caring for an in-home patient about one-sixth the cost of hospitalization.

While certain fees can be charged to insurance, Hospital at Home is largely unfunded by private insurers and Medicare, especially plans that operate under fee-for-service arrangements. Wendorff said Mount Carmel ensures that no patient pays more out-of-pocket costs for the care than he or she would for hospital care.

Conrad said home is "100 percent" better than the hospital, allowing his wife to help with his care and avoid half-hour drives to Mount Carmel East.

"It's more relief on you. You're not worried about your family," he said. "You're home, and they're able to visit you and take care of you at the same time."