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Patel R, Thornton-Swan TD, Armitage LC, Vollam S, Tarassenko L, Lasserson DS, Farmer AJ. Remote Vital Sign Monitoring in Admission Avoidance Hospital at Home: A Systematic Review. J Am Med Dir Assoc 2024; 25:105080. [PMID: 38908399 DOI: 10.1016/j.jamda.2024.105080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES To examine randomized controlled trials (RCTs) of "hospital at home" (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use of vital sign monitoring approaches and evidence for their effectiveness. DESIGN Systematic review. SETTING AND PARTICIPANTS This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment, and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices. METHODS Eligible studies were identified through updated database and trial registries searches (March 2, 2016, to February 15, 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach. RESULTS Twenty-one eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterized: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78-1.12), 3-monthly readmission to hospital RR 1.02 (0.77-1.35), and length of stay mean difference 1.91 days (0.71-3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95% CI 0.11-0.86). CONCLUSIONS AND IMPLICATIONS This review highlights gaps in the reporting and evidence base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.
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Affiliation(s)
- Rajan Patel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
| | | | - Laura C Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom; OxINMAHR, Oxford Brookes University, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Daniel S Lasserson
- Warwick Medical School Health Sciences Division, University of Warwick, Warwick, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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García-Marichal C, Aguilar-Jerez MF, Delgado-Plasencia LJ, Pérez-Hernández O, Armas-González JF, Pelazas-González R, Martín-González C. A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality. J Gen Intern Med 2024:10.1007/s11606-024-08912-6. [PMID: 39023662 DOI: 10.1007/s11606-024-08912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. OBJECTIVE The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. DESIGN Retrospective cohort study. PATIENTS We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. MAIN MEASURES Primary outcome was to assess risk of admission or mortality. KEY RESULTS 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82-142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19-34.48), obesity (RR: 1.53 (1.12-2.10), chronic kidney disease (RR:2.31 (1.23-4.35), ≥ 60 years of age (RR: 1.44 (1.04-1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15-55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62-10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70-15.15), chronic respiratory disease (RR: 3.32 (1.43-7.69) and active malignancy (RR: 4.00 (1.42-11.23). CONCLUSIONS Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.
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Affiliation(s)
| | | | | | | | | | | | - Candelaria Martín-González
- Hospital Universitario de Canarias, San Cristóbal De La Laguna, Spain.
- Universidad de La Laguna, San Cristóbal De La Laguna, Spain.
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Servicio de Medicina Interna, Hospital Universitario de Canarias, Canary Islands, Tenerife, Spain.
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3
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Jain SH. Curing Ourselves of Toxic Positivity for Hospital-at-Home. JACC. HEART FAILURE 2024; 12:1300-1301. [PMID: 38960524 DOI: 10.1016/j.jchf.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Sachin H Jain
- SCAN Group and Health Plan, Long Beach, California, USA; Stanford University School of Medicine, Stanford, California, USA; West Los Angeles VA Medical Center, Los Angeles, California, USA.
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Siu AL, Leff B. Importance of early consideration of scaling and sustainability for aging-related care models: Case study of Hospital at Home. J Am Geriatr Soc 2024. [PMID: 38943488 DOI: 10.1111/jgs.19042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/01/2024]
Abstract
For aging-related research, there is a pressing need to attend to the dissemination and implementation of evidence-based interventions. Some aging-related interventions with established effectiveness may be poorly disseminated and implemented due to behavioral, organizational, payment, or other constraints. To provide insight into the beginning to end process of translation and implementation, we present a case history of the three-decade progression of Hospital at Home (HaH) now nearing national dissemination. We summarize research at various phases with particular attention to implementation considerations. Reviewing over three decades of HaH-related research dating from initial discovery to translation and implementation, we found that the content and importance of different constructs (e.g., inner practice vs. outer environmental setting) and the choice of implementation strategies differed depending on implementation context (testing of effectiveness, scaling, or sustainability). Early effectiveness studies mostly examined implementation issues related to the intervention, the practice setting, and the individuals involved. However, explicit and early consideration of scale and sustainment was not the primary focus. For example, HaH program intake is primarily through hospital emergency departments (ED). Initial efforts would have benefited from incorporating strategies (e.g., incorporating ED leadership into program leadership) to address night and weekend admissions. Many regulatory barriers did not surface during initial considerations. Considering implementation issues late may contribute to delay in bringing discoveries to population impact. The experience with HaH suggests that scale and sustainability bear earlier consideration because barriers and facilitators to implementation are likely to be different in content and importance at different phases of implementation.
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Affiliation(s)
- Albert L Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC) at the James J. Peters VA Medical Center, Bronx, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Weijers J, Prins MLM, van Dam DGHA, van Nieuwkoop C, Alsma J, Haak HR, V Uffen JW, Kaasjager KAH, Kremers MNT, Nanayakkara PWB, Stassen PM, Groeneveld GH. Patients' Perspectives and Feasibility of Home Monitoring in Acute Care: The AcuteCare@Home Flash Mob Study. Telemed J E Health 2024. [PMID: 38938204 DOI: 10.1089/tmj.2024.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Objective: To determine patients' perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians' perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient's prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55-78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ≥3; 29.5% clinical frailty score ≥5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care.
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Affiliation(s)
- Jari Weijers
- Division of Acute Medicine, Department of Internal Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Manon L M Prins
- Division of Acute Medicine, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Davy G H A van Dam
- Division of Acute Medicine, Department of Internal Medicine, St Jans Gasthuis, Weert, The Netherlands
| | - Cees van Nieuwkoop
- Division of Acute Medicine, Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jelmer Alsma
- Division of Acute Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Harm R Haak
- Division of Acute Medicine, Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem V Uffen
- Division of Acute Medicine, Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Karin A H Kaasjager
- Division of Acute Medicine, Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein N T Kremers
- Division of Acute Medicine, Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Prabath W B Nanayakkara
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Patricia M Stassen
- Division of Acute Medicine, Department of Internal Medicine, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert H Groeneveld
- Division of Acute Medicine, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Sandreva T, Larsen MN, Rasmussen MK, Nielsen TL, von Sydow C, Schmidt TA, Fischer TK. Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study. J Telemed Telecare 2024:1357633X241254572. [PMID: 38780386 DOI: 10.1177/1357633x241254572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. METHODS A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. RESULTS Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. CONCLUSIONS The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.
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Affiliation(s)
- Tatjana Sandreva
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maria Normand Larsen
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Infectious and Pulmonary Disease, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Charlotte von Sydow
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Thomas Andersen Schmidt
- Department of Emergency Medicine, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea K Fischer
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Pandit JA, Pawelek JB, Leff B, Topol EJ. The hospital at home in the USA: current status and future prospects. NPJ Digit Med 2024; 7:48. [PMID: 38413704 PMCID: PMC10899639 DOI: 10.1038/s41746-024-01040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
The annual cost of hospital care services in the US has risen to over $1 trillion despite relatively worse health outcomes compared to similar nations. These trends accentuate a growing need for innovative care delivery models that reduce costs and improve outcomes. HaH-a program that provides patients acute-level hospital care at home-has made significant progress over the past two decades. Technological advancements in remote patient monitoring, wearable sensors, health information technology infrastructure, and multimodal health data processing have contributed to its rise across hospitals. More recently, the COVID-19 pandemic brought HaH into the mainstream, especially in the US, with reimbursement waivers that made the model financially acceptable for hospitals and payors. However, HaH continues to face serious challenges to gain widespread adoption. In this review, we evaluate the peer-reviewed evidence and discuss the promises, challenges, and what it would take to tap into the future potential of HaH.
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Affiliation(s)
- Jay A Pandit
- Scripps Translational Research Institute, Scripps Research, La Jolla, CA, USA.
| | - Jeff B Pawelek
- Scripps Translational Research Institute, Scripps Research, La Jolla, CA, USA
| | - Bruce Leff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Topol
- Scripps Translational Research Institute, Scripps Research, La Jolla, CA, USA
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Abstract
Hospital at Home (HaH) provides hospital-level services in the home to eligible patients who would otherwise require facility-based hospitalization. In the last two decades, studies have shown that HaH can improve patient outcomes and satisfaction and reduce hospital readmissions. Improved technology and greater experience with the model have led to expansion in the scope of patients served and services provided by the model, but dissemination in the United States has been hampered by lack of insurance coverage until recently. HaH is likely at the tipping point for wide adoption in the United States. To realize its full benefits, HaH will need to continue volume expansion to achieve culture change in clinical practice as facilitated by increased insurance coverage, technological advancements, and improved workforce expertise. It is also essential that HaH programs maintain high-quality acute hospital care, ensure that their benefits can be accessed by hard-to-reach rural populations, and continue to advance health equity.
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Affiliation(s)
- Tuyet-Trinh Truong
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;
| | - Albert L Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;
- Geriatrics Research, Education, and Clinical Center (GRECC) at the James J. Peters VA Medical Center, Bronx, NY, USA
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Desai MP, Ross JB, Blitzer S, Como N, Horton DJ, Ostergar J, Hernández C, Levine DM. Hospital-Level Care at Home for Acutely Ill Adults in Rural Settings: Proof of Concept. Home Healthc Now 2024; 42:21-30. [PMID: 38190160 DOI: 10.1097/nhh.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Residents in rural areas face barriers to accessing acute care. Rural home hospital (RHH) or delivery of acute care at home could represent an important clinical care model. This study assessed the feasibility and acceptability of RHH as a substitute to traditional hospital care. Patients were cared for by a remote RHH attending physician and an RHH registered nurse deployed to the home. The study team conducted daily check-ins with RHH clinicians to assess workflows for completion. Surveys assessed patient experience and qualitative interviews assessed perceived acceptability, safety, and quality of care. We completed qualitative analysis of the interviews and coded qualitative data into domains and subdomains through an iterative process. RHH was successfully deployed to three acutely ill patients in rural Utah. RHH admission, daily care, and discharge processes were accomplished for each patient. From qualitative analysis, we identified four domains: (1) Perceived comfort level during RHH admission, (2) Perceived safety during RHH admission, (3) Perceived quality of care during RHH admission, and (4) Perception of RHH workflows. We found acute care was delivered to rural homes with satisfactory patient and clinician experience. Team dynamics, technology build, robust clinical and operational workflows, and care coordination were important to a successful admission. Learnings from this study can inform program design and training for RHH teams and startup for larger RHH evaluation. Home hospital care is expanding rapidly in the United States and RHH could represent an important clinical care model.
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Achanta A, Wasfy JH, Moss CT, Cherukara A, Ho D, Boxer R, Schmieding M, Phadke NA, Thompson R, Levine DM, Weiner RB. Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care. Circ Cardiovasc Qual Outcomes 2024; 17:e010031. [PMID: 38054286 DOI: 10.1161/circoutcomes.123.010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. METHODS Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. RESULTS We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. CONCLUSIONS About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.
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Affiliation(s)
- Aditya Achanta
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Jason H Wasfy
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - David Ho
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Malte Schmieding
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Neelam Ameya Phadke
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Allergy and Immunology Division (N.P.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ryan Thompson
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Michael Levine
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Rory B Weiner
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
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Tsujimoto Y, Kobayashi M, Oku T, Ogawa T, Yamadera S, Tsukamoto M, Matsuda N, Nishihira M, Terauchi Y, Tanaka T, Kawabata Y, Miyamoto Y, Morikami Y. Outcomes in novel hospital-at-home model for patients with COVID-19: a multicentre retrospective cohort study. Fam Pract 2023; 40:662-670. [PMID: 36723907 PMCID: PMC10745271 DOI: 10.1093/fampra/cmad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with coronavirus disease (COVID-19). Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organized by a team of local primary care clinics. METHODS We conducted a multicentre retrospective cohort study of the COVID-19 patients who received our HaH care from 1 January to 31 March 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka city were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. RESULTS Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only 1 home visit in addition to online treatment. CONCLUSIONS The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.
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Affiliation(s)
- Yasushi Tsujimoto
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoecho, Sakyo-ku, Kyoto, Japan
| | | | - Tomohisa Oku
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
| | - Takahisa Ogawa
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
| | | | | | | | | | - Yu Terauchi
- Terauchi Clinic, Dotonbori 1 Chomehigashi 5-5, Chuo-ku, Osaka, Japan
| | - Takahiro Tanaka
- Minato Clinic, Nagarahigashi 1-4-24-102, Kita-ku, Osaka, Japan
| | | | - Yuki Miyamoto
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
| | - Yoshiki Morikami
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
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Arora S, Puius YA. Community-Acquired Pneumonia. N Engl J Med 2023; 389:1633. [PMID: 37888933 DOI: 10.1056/nejmc2310748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
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González Anglada MI, Garmendia Fernández C, Moreno Núñez L. [Home hospitalisation: Opportunities and needs]. J Healthc Qual Res 2023; 38:195-196. [PMID: 36872155 DOI: 10.1016/j.jhqr.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023]
Affiliation(s)
- María Isabel González Anglada
- Hospitalización a Domicilio, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alorcón, Madrid, España.
| | - Cristina Garmendia Fernández
- Hospitalización a Domicilio, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alorcón, Madrid, España
| | - Leonor Moreno Núñez
- Hospitalización a Domicilio, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alorcón, Madrid, España
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Khera N, Knoedler M, Meier SK, TerKonda S, Williams RD, Wittich CM, Coffey JD, Demaerschalk BM. Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There? TELEMEDICINE REPORTS 2023; 4:100-108. [PMID: 37283856 PMCID: PMC10240289 DOI: 10.1089/tmr.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
Background A steep increase in the use of delivery of virtual care occurred during the COVID-19 public health emergency (PHE) because of easing up of payment and coverage restrictions. With the end of PHE, there is uncertainty regarding continued coverage and payment parity for the virtual care services. Methods On November 8, 2022, The Mass General Brigham held the Third Annual Virtual Care Symposium: Demystifying Clinical Appropriateness in Virtual Care and What's Ahead for Pay Parity. Results In one of the panels, experts from Mayo Clinic led by Dr. Bart Demaerschalk discussed key issues related to "Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?" The discussions centered around current policies around payment and coverage parity for virtual care, including state licensure laws for virtual care delivery and the current evidence base regarding outcomes, costs, and resource utilization associated with virtual care. The panel discussion ended with highlighting next steps targeting policymakers, payers, and industry groups to help strengthen the case for parity. Conclusions To ensure the continued viability of virtual care delivery, legislators and insurers must address the coverage and payment parity between telehealth and in-person visits. This will require a renewed focus on research on clinical appropriateness, parity, equity and access, and economics of virtual care.
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Affiliation(s)
- Nandita Khera
- Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Meghan Knoedler
- Revenue Strategy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah K. Meier
- Communications Department, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarvam TerKonda
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
- Federation of State Medical Boards, Euless, Texas, USA
| | - Ryan D. Williams
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Bart M. Demaerschalk
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
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Zawada SK, Sweat J, Paulson MR, Maniaci MJ. Staff Successes and Challenges with Telecommunications-Facilitated Patient Care in Hybrid Hospital-at-Home during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091223. [PMID: 37174766 PMCID: PMC10178711 DOI: 10.3390/healthcare11091223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Technology-enhanced hospital-at-home (H@H), commonly referred to as hybrid H@H, became more widely adopted during the COVID-19 pandemic. We conducted focus group interviews with Mayo Clinic staff members (n = 14) delivering hybrid H@H in three separate locations-a rural community health system (Northwest Wisconsin), the nation's largest city by area (Jacksonville, FL), and a desert metropolitan area (Scottsdale, AZ)-to understand staff experiences with implementing a new care delivery model and using new technology to monitor patients at home during the pandemic. Using a grounded theory lens, transcripts were analyzed to identify themes. Staff reported that hybrid H@H is a complex care coordination and communication initiative, that hybrid H@H faces site-specific challenges modulated by population density and state policies, and that many patients are receiving uniquely high-quality care through hybrid H@H, partly enabled by advances in technology. Participant responses amplify the need for additional qualitative research with hybrid H@H staff to identify areas for improvement in the deployment of new models of care enabled by modern technology.
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Affiliation(s)
- Stephanie K Zawada
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and Science, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, 712 Broadway St. S, Menomonie, WI 54751, USA
| | | | - Michael J Maniaci
- Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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Lalanza S, Peña C, Bezos C, Yamauchi N, Taffner V, Rodrigues K, Garcia Manrique M, Rubio Jareño A, Lemos Gil A. Patient and Healthcare Professional Insights of Home- and Remote-Based Clinical Assessment: A Qualitative Study from Spain and Brazil to Determine Implications for Clinical Trials and Current Practice. Adv Ther 2023; 40:1670-1685. [PMID: 36795221 PMCID: PMC9933016 DOI: 10.1007/s12325-023-02441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The SARS-CoV-2 virus pandemic has accelerated the growing trend towards using home- and remote-based medical testing (H/RMT). The aim of this study was to gather insights and explore the opinions of patients and healthcare professionals (HCPs) in Spain and Brazil regarding H/RMT and the impact of decentralised clinical trials. METHODS This qualitative study consisted of in-depth open question interviews of HCPs and patients/caregivers followed by a workshop that aimed to determine the advantages and barriers to H/RMT in general, and in the context of clinical trials. RESULTS There were 47 participants in the interviews (37 patients, 2 caregivers, 8 HCPs) and 32 in the validation workshops (13 patients, 7 caregivers, 12 HCPs). The main advantages for the use of H/RMT in current practice were the comfort and convenience, the ability to improve the relationship between HCPs and patients and personalise patient care, and the increased patient awareness towards their disease. Barriers to H/RMT included accessibility, digitalisation, and the training requirements for both HCPs and patients. Furthermore, according to the Brazilian participants, there is a general distrust in the logistical management of H/RMT. Patients indicated that the convenience of H/RMT did not influence their decision to participate in a clinical trial, with the main reason for participating in a clinical trial being to improve health; however, H/RMT in clinical research does aid adherence to the long-term follow-up associated with trials and provides access to patients living far from the clinical sites. CONCLUSION Insights from patients and HCPs suggest that the advantages of H/RMT may outweigh the barriers, and that social, cultural and geographical factors and the HCP-patient relationship are critical aspects to be considered. Moreover, the convenience of H/RMT does not appear to be a driver for participating in a clinical trial but can facilitate patient diversity and study adherence.
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Affiliation(s)
- Simón Lalanza
- Instituto de Experiencia del Paciente en C/Mieses 1, Majadahonda, 28220 Madrid, Spain
| | - Catalina Peña
- Instituto de Experiencia del Paciente en C/Mieses 1, Majadahonda, 28220 Madrid, Spain
| | - Carlos Bezos
- Instituto de Experiencia del Paciente en C/Mieses 1, Majadahonda, 28220 Madrid, Spain
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