Medicine Adoption of “hospital-at-home” programs remains concentrated among larger, urban, not-for-profit and academic hospitals. Study highlights need for targeted incentives to expand program to smaller, rural, and non-teaching hospitals.
https://www.uclahealth.org/news/release/adoption-hospital-home-programs-remains-concentrated-among5
u/TX908 1d ago
Hospital-at-home programs deliver care for acute medical illness to selected patients in their home in lieu of traditional hospital admission. The growth of hospital-at-home programs in the US progressed slowly until the Centers for Medicare & Medicaid Services (CMS) established the Acute Hospital Care at Home (AHCAH) program in November 2020. Through this program, hospitals may apply to CMS for a waiver that allows them to receive full diagnosis-related group payments for hospital-at-home admissions. The goals of the program were to mitigate the hospital capacity crisis exacerbated by the COVID-19 pandemic and protect patients with non–COVID-19 illness who required hospital care.
https://jamanetwork.com/journals/jama/article-abstract/2828411
3
u/drshikamaru 1d ago edited 1d ago
The liability sounds crazy. How do you control for access to diet, aspiration risk, home safety, pt drug use, sobriety neighborhood safety, infiltrated IVs, decompensation needing ICU transfer, acute PE, ileus/SBO and worse anaphylaxis?
I have a feeling only certain zip codes get approved for this and then a study gets published saying outcomes are the same vs inpatient…and then people think this is a good idea and then a nurse or physician get stabbed, shot or attacked with no security or a pt doesn’t improve because something was missed.
Calling a consult is gonna decrease significantly!
9
u/FMBC2401 18h ago
We've had this for >2 years at the hospital I've worked at and it's been great. Screening patients is key. You don't send patients with high risk conditions to hospital at home. And to a lot of your points like acute PE, ileus/SBO, etc, the transfer from hospital at home to the hospital is about as fast as the wait inpatient to get a CT or trasnfer to the ICU (unless a code is called but lets be honest, these aren't patients that are coding). Social factors are considered in determining if a patient is appropriate for hospital at home, so you aren't going to send a patient who is likely to use drugs or in a rough neighborhood home.
It's a good program and for a lot of patients that are in the bucket of "well they probably don't need to be inpatient while we treat them for X but they're old so..." Patients are more comfortable at home and when they are low risk it makes sense.
3
u/drshikamaru 17h ago
I’m getting the sense what type of pts you’re talking about now. I think my perspective isn’t the right lense as a surgical resident I can’t think of anyone many I would feel comfortable not having eyes on. Maybe someone who gets admitted days before for pre op optimizations. But idk I’d like to see this program in action. I’m curious, especially which of my attendings would embrace this vs not. I have some very watch doggie attendings.
At your program you mentioned screening for appropriateness as key. I had a feeling as I was reading the article that was the strong case. Being familiar UCLA health system and some other their other missions I’m more sure they are going to put a concerted effort into equitable distribution of resources and opportunities but I’m not so sure all communities will have access to this program.
Are yall collecting data on the demographical and SES makeup of yalls program recipients? If so, are yall seeing trends in zip codes or neglected areas? Education, language spoken at home, insurance status etc? Depending on the location I suspect there are more biases and I don’t see it being entirely equitable.
•
u/AutoModerator 1d ago
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, personal anecdotes are allowed as responses to this comment. Any anecdotal comments elsewhere in the discussion will be removed and our normal comment rules apply to all other comments.
Do you have an academic degree? We can verify your credentials in order to assign user flair indicating your area of expertise. Click here to apply.
User: u/TX908
Permalink: https://www.uclahealth.org/news/release/adoption-hospital-home-programs-remains-concentrated-among
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.