Home is where the hospital is

June 23, 2022  //  FOUND IN: Strategy & Leadership,

As U-M Health hospitals filled up rapidly during the pandemic, care teams were forced to adapt with the changing times and design new care methods that extended beyond the hospital setting.

The Care at Home program was developed to help patients safely shorten a hospital stay or receive certain hospital-level treatments at home without being admitted as an inpatient.

The new program proved so successful in completing COVID-19 treatments at home that the team began to expand services and include care pathways.

As part of the BASE strategic priorities, Care at Home is a key driver to expanding our patients’ access to care.

Grace Jenq, M.D., the geriatrician who directs post-acute care services at Michigan Medicine, now leads a growing team of physicians, nurses and other health care professionals who provide patients with access to safe, hospital-level care in the comfort of their own home.

“Across the nation, people are trying to figure out how virtual care and home visits can help with keeping patients out of the hospital or sending them home as soon as it’s safe to do so,” said Jenq, adding that “the Care at Home program is really about making sure that the right care is provided at the right place at the right time.”

How Care at Home works

When certain patients receive treatment and monitoring at home, capacity is freed up for patients whose care requires a hospital setting. Thus, the program not only enhances the patient experience but also builds greater access for those needing inpatient care.

Care at Home services coincide with existing Michigan Medicine pathways. These include Ed to Home, Completion at Home, Direct Enrollment to Program, OBS to Home and Inpatient Transfer to Home. Treatments available through care at home include imaging, intermittent catheterizations, respiratory treatments, IV antibiotics and more.

Jenq and her team run multiple programs that treat patients in their own home, while also supplementing with virtual connections between visits. The team monitors blood pressure, temperature and other vital signs, along with a daily symptoms survey patients can take from their own home. Bluetooth-enabled devices are then used to share this data with nurses and health providers at Michigan Medicine.

Care at Home bridges the gap between hospital care and complete independence for many patients. With the technology utilized by the Care at Home team, patients can be monitored at home with medical personnel on standby to intervene if any problems arise.

Encouraging providers to refer

Soumya Rangarajan, M.D., M.P.P., the geriatrician who serves as medical director for Michigan Medicine’s hospital-level care at home, recently shared national and global studies from health care systems with active hospital-at-home care.

“These studies show equivalent quality of care, with lower cost, and greater patient satisfaction, compared with in-hospital care for the enrolled patients,” she said.

“Despite this evidence,” she added, “some emergency providers and hospital-based physicians may hesitate to make a referral because they may feel patients may not qualify medically.”

Even if patients qualify medically, they must also be covered by an insurance plan that participates in the program and must reside within the area served by the Michigan Medicine team.

Doctors, nurses and other staff are encouraged to discuss the Care at Home program with their patients if they prove to be a good candidate and fall within the pathways previously outlined.

For questions about Care at Home, call the team 24×7 at pager 61576.

New opportunities for nurses

Care at Home programs also spur the hiring of additional nurses. This care modelrequires more registered nurses, as well as physical and occupational therapists on staff to provide in-home care to patients.

Care at Home programs provide opportunities for nurses who are interested in working from home while monitoring patients, as well as physicians, physician assistants and nurse practitioners who can make the house calls needed to replicate hospital-level care.

“Nurses and providers are really interested in this model, which is new and innovative and gives them a chance to connect with patients in a different space,” said Jenq.

Looking forward

Rangarajan also noted that the Michigan Medicine team is working to expand access to Care at Home, including ways for certain outpatient clinics to directly refer a patient to the service, bypassing the emergency department or hospitalization. As more patients enroll in Care at Home and more time passes with the program operational, research can be done to see the true long-term effects that Care at Home has on patient costs and well-being.

Michigan Medicine is ahead of the game compared to many other at-home care programs in the country, with readings from at-home monitoring and notes from visits going directly into the patient’s electronic health record.

The team also encourages patients to consider the care option for themselves and consult their physicians on whether they would be a good candidate.

“We and other hospitals are amping up what we can provide at home, so it’s absolutely a good idea for patients who are hospitalized or in an emergency room to talk to their doctors and nurses about Care at Home,” said Jenq. “If the physician is unsure if they qualify, the team is available 24×7 to answer questions. When patients initiate the conversation, then we create plans uniquely tailored to them, and work to keep them at home if that’s the best option for them.”

“We have experienced many early successes,” Jenq added. “Now it is important to keep the momentum going. To reach our goal of an average daily census (ADC) of 10 patients, we need everyone’s help. We encourage everyone to consider their patients for this unique care model.

To refer a patient or ask questions about Care at Home, call pager 61576 or visit the Care at Home website for more information.

This story was adapted from a Michigan Medicine health blog. To read that full story, click here.