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HOME HOSPITAL By Patrick Whitledge PA-S2

HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

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Page 1: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

HOME HOSPITALBy Patrick Whitledge PA-S2

Page 2: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

INTRODUCTION• Hospital at Home provides safe, high-quality, hospital-

level care to older adults in the comfort of their own homes.

Page 3: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

INTRODUCTION• Developed by the Johns Hopkins Schools of Medicine and

Public Health and tested at medical centers across the country, this innovative care model lowers costs by nearly one-third, and reduces complications.

Page 4: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• A patient requiring admission for one of the “target

illnesses” is identified in the local Emergency Department. Staff assesses if the patient is a good candidate for the program using validated criteria.

Page 5: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

Appropriate Candidates• Who are appropriate candidates?• Patients with (target) illnesses including community-

acquired pneumonia, congestive heart failure, chronic obstructive pulmonary disease (emphysema), cellulitis, volume depletions / dehydration, urinary tract infection / urosepsis, deep venous thrombosis and pulmonary embolism, are consider good candidates for home hospital.

• Usually patients will be 65 and older

Page 6: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

Appropriate Candidates• A study was performed by John Hopkins Bayview Medical

Center titled: Prospective evaluation of clinical criteria to select older persons with acute medical illness for care in a hypothetical home hospital.

• This study define criteria that can identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital.

• The study looked at around 150 charts and a comprehensive medical team determined that around 33% of the patients could have been managed with a home hospital model.

Page 7: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• If ER staff finds the patient to be eligible the patient must

then consent to participate in the Home Hospital model. After that a Hospital at Home physician evaluates the patient. The patient is then transported home, usually by ambulance.

Page 8: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• Once home, the patient receives extended nursing care

for the initial portion of their admission, and then at least daily nursing visits according to clinical need. Nurses are available 24 hours a day/7 days a week for any urgent or emergent situation.

Page 9: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• The patient is evaluated daily by the Home Hospital

physician who completes an assessment and continues to implement appropriate diagnostic and therapeutic measures. The physician makes one or more home visits per day and is available 24 hours a day/7 days a week for any urgent or emergent situation.

Page 10: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• The patient can receive diagnostic studies such as

electrocardiograms, echocardiograms, and x-rays at home, as well as treatments, including oxygen therapy, intravenous fluids, intravenous antibiotics, and other medicines, respiratory therapy, pharmacy services, and skilled nursing services.

• Diagnostic studies and therapeutics that cannot be provided at home, such as computerized tomography, magnetic resonance imaging, or endoscopy, are available via brief visits to the acute hospital.

Page 11: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

How it Works?• Once treatment is complete the patient is discharged from

the home hospital’s physician and is instructed to follow up with their primary care physician.

Page 12: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

Why?• When compared to traditional hospital stays, studies show

that home hospital patients are less likely to experience complications such as delirium and are less likely to require sedative type medications or restraints.

• Family also has greater access to the patient and reports feeling less stress during the course of care.

Page 13: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

Why?• In quality insurance studies both patients and family report

a greater level of satisfaction with the home hospital model then a traditional hospital stay.

• Overall cost have been shown to be 60% less then traditional hospital stays.

Page 14: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

History• The concept was created in 1995 by Dr. John Burton, of

Johns Hopkins School of Medicine, and Dr. Donna Regenstreif of The John A Hartford Foundation

• A geriatric study team led by Dr. Bruce Leff developed medical eligibility criteria and the basic clinical model and designed the study and measurement methodology. (the article previously discussed)

Page 15: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

History• In 1996 a 17 patient pilot trail was performed to ensure

the method was feasible and safe: http://www.hospitalathome.org/files/Pilot.pdf

• The result was that all 17 patients were safely treated and the cost to the patient was 60% less then a traditional hospital stay.

Page 16: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

History• In 2010 A public/private partnership tested a modified

model of Home Hospital, in which home-based care is provided by nurses, with physician consult via biometrically enhanced two-way telemedicine-video. The new model is also managed by a physician group, instead of a hospital.

Page 17: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

Current Programs• Presbyterian Health Services, Albuquerque, New Mexico• Veterans Affairs Medical Center, Boise, Idaho• Veterans Affairs Medical Center, Honolulu, Hawaii• Veterans Affairs Medical Center, New Orleans, Louisiana• Veterans Affairs Medical Center, Philadelphia,

Pennsylvania• Veterans Affairs Medical Center, Portland, Oregon• Veterans Affairs Medical Center, Bend, Oregon

Page 18: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

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Page 19: HOME HOSPITAL By Patrick Whitledge PA-S2. INTRODUCTION Hospital at Home provides safe, high-quality, hospital- level care to older adults in the comfort

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