New Care Model

Sonya Collins

They say that necessity is the mother of invention—an adage that has been borne out in the pandemic. While the hospital-at-home model was not invented during the pandemic, COVID-19 has prompted health care facilities to launch programs that may have been in the works for years. A November 2020 waiver that CMS issued, which allows hospitals to provide acute fee-for-service care outside of the confines of brick-and-mortar medical centers, was the final push hospitals needed to realize these plans.

Clinicians who practice with the hospital-at-home model predict the new care setting is here to stay, and pharmacists will be included.

“The pharmacist plays a vital role in the long-term success of the program because so many readmissions are due to medication problems,” said Alisa Thomas, PharmD, clinical pharmacy manager at Intermountain Homecare and Hospice in Salt Lake City, Utah.

Acute hospital-level care at home

The hospital-at-home model is not to be confused with hospice, home health, or other chronic or palliative care that takes place in residential settings. This model brings acute hospital-level care and surveillance into the home in order to save hospital beds for those who could not get the care they need at home.

Research shows that these programs result in better clinical outcomes; shorter average hospital stays (3.2 days vs. 4.9 days); higher patient and family satisfaction; fewer tests; fewer hospital-associated complications, such as delirium, infections, and need for sedatives or restraints; and up to 30% lower costs.

How these programs are run varies across hospitals. Mayo Clinic’s Wisconsin-based program, for example, sends health care providers to the home in person multiple times each day. In addition, patients have an iPad, a smart watch, and a landline that Mayo installs which they can use to reach their care team at the touch of a button. Utah-based Intermountain Health dispatches nurses to the home once or twice per day in addition to a daily phone call. A video visit platform is in the works.

In addition to conserving hospital beds for the most critically ill patients, hospital-at-home programs have served to limit COVID-19 exposures as much as possible during the pandemic. What’s more, the programs allow patients to stay with their families at a time when hospital visitation has been eliminated in many medical centers.

“Being able to help patients stay home with their families, especially during the holidays and when we don’t allow visitors in the hospital, is what’s made the greatest impact on me and why I love this program so much,” Thomas said.

Pharmacists drive outcomes at home

According to some estimates, more than 1 in 4 hospital readmissions are medication-related. The home-based model gives pharmacists a window into how patients will manage their own care at home once fully discharged, which can help prevent some medication-related readmissions. Readmission rates are a critical measure of hospital-at-home success.

“Hospital care at home gives you insight into adherence,” said Maggie Peinovitch, PharmD, senior pharmacy manager of operations at Mayo Clinic’s Eau Claire, WI, campus. “Being in the home, you get a clearer picture and a better understanding of how the patient will manage once they are discharged. Prior to this program, we just didn’t have great insight into that. We relied on electronic resources and calling pharmacies, but we were still missing a part of the picture.”

Through in-person home visits or video visits, pharmacists can verify that patients are taking their medications correctly. They can streamline medication lists by eliminating duplicates and prescriptions that may no longer be necessary. They can also identify ways to save the patient money, which improves adherence.

Pharmacists play various roles in the model, from consulting with prescribers and other clinicians to educating patients and caregivers and meeting with them via phone or video or at the bedside.

“It’s a unique blend of inpatient and outpatient,” Peinovitch said. “If you’re an inpatient or an outpatient pharmacist, it will push you out of your comfort zone and challenge you to take a holistic approach to every patient.”