Hospital at home: A shift in thinking for acute care

In the past, innovation in healthcare in the acute setting was heavily focused on improvements in procedural interventions or critical care. Recently, however, there has been a shift and developing interest in care at home. As a result, many tech-enabled care delivery improvements are being focused on the home. In addition, clinical necessity, driven by the pandemic, has required healthcare systems deliver better care beyond the four walls of the hospital.

Enter hospital at home.

In November 2020, the Centers for Medicare & Medicaid Services announced the Acute Hospital Care at Home program. Although the hospital at home model dates back to the 1990s, there was limited adoption due to reimbursement constraints. Because of the unprecedented burdens during the pandemic, such as bed shortages and limited resources and staff, CMS implemented the program to allow for health systems to deliver care to patients safely and efficiently. Since the announcement, 203 hospitals across 92 health systems in 34 states have been approved to deliver acute care in the home.¹ Even though the issues faced during the pandemic have improved, the AHCAH program has helped transform the traditional healthcare system and led hospitals, clinicians and lawmakers to rethink the way care is delivered.

In hospital at home, clinically appropriate, acutely ill patients can receive inpatient-level care in the comfort of their own homes. According to CMS guidelines, patients can be admitted from the emergency department or inpatient floor after they an evaluation by a physician. Once admitted, the patient receives twice-daily, in-person visits from a registered nurse or mobile integrated health paramedic in addition to a visit by a physician or advanced practice provider (this evaluation can be virtual). The patient should have immediate, on-demand remote access to the care team (through audio communication) and should be reachable within 30 minutes if decompensating. In an effort to monitor patients more closely, patients can be outfitted with wearable devices that provide continuous monitoring and vitals collection. Depending on the solution, this data can be relayed, in near real-time to the hospital. Remotely monitoring patients empowers providers to efficiently track their hospital at home patients and revise care plans as needed.

In addition to patient monitoring, facilitating patient-to-clinician communication (via video, audio, and text) and care team task management/coordination are key features to consider in a hospital at home solution. Biofourmis’ [email protected]™ platform is a robust platform with many configurable tools to help hospitals quickly implement and scale their hospital at home programs.

As discussed earlier, technology is a key component of successful hospital-at-home programs. The solution should be easy to use for patients and clinicians alike while improving the quality of care delivered in the home. The old model of sending episodic collection devices, the patient burdened with manually inputting all their vitals, is over. Now, hospitals can instead utilize more comfortable, wearable technologies to automatically, continuously, and securely collect/share patient health data in real time. The best solutions are designed to be both modular and device-agnostic.

Given the sheer amount of information provided by intermittent and continuous monitoring, it is important to consider a solution that utilizes algorithms and analytics to sort signals from noise and create relevant, clinical insights. One example is Biofourmis’ Biovitals Index (BI). Through the use of FDA-cleared software the BI is able to support clinical decision making and reduce the frequency of false alerts. Instead of simply relaying a constant stream of data, these algorithms deliver practical insights using artificial intelligence (AI) and machine learning. This analysis can detect deviations within a patient’s vital signs and help to facilitate earlier interventions.

Each health system is unique, and no one hospital at home program can be the same. It is important to find a partner that is willing to create and configure a solution that works for a program’s needs.

Previous studies have shown that the hospital at home model leads to improved outcomes, increased patient satisfaction, and decreased resource utilization. A recently published RCT from Brigham and Women’s Hospital found that hospital at home delivered²:

• 38% reduction in costs
• 70% reduction in readmissions
• 50% improvement in patient mobility

According to the American Hospital Association, an analysis of 61 trials found the mortality rate was 20% lower among patients treated at home compared to those who remained in the hospital. Finally, patient feedback suggests that they enjoy receiving treatment from the comfort of their own homes and are largely satisfied with their care.³

Biofourmis—a fast-growing global leader in digital therapeutics and virtual care that powers personalized predictive care—discovers, develops and delivers clinically validated software-based therapeutics to provide better outcomes for patients.

For more information: www.biofourmis.com