Health equity in Hospital at Home: Outcomes for economically disadvantaged and non‐disadvantaged patients

Siu, Albert L.; Zhao, Duzhi; Bollens‐Lund, Evan; Lubetsky, Sara; Schiller, Gabrielle; Saenger, Pamela; Ornstein, Katherine; Federman, Alex D.; DeCherrie, Linda V.; Leff, Bruce

doi:10.1111/jgs.17759

Cited by 17 publications

(12 citation statements)

References 6 publications

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“…HH programs can similarly be used to tackle disparities in access to quality postoperative care if they are similarly designed with these elements and stakeholders in mind. Additionally, HH programs could potentially decrease disparities in surgical care by increasing provider knowledge of social determinants of health that patients face, information that could be used to connect patients to resources and improve surgical outcomes 37 .…”

Section: Secure and Equitable Accessmentioning

confidence: 99%

“…Broadband and other IT infrastructure to support these technologies should also be made more widely available and affordable 40 . While some early studies suggest HH can be delivered successfully to patients with lower socioeconomic statuses, surgical HH programs must intentionally design protocols to ensure equal access for all patients 37 . Surgical HH programs designed with equity in mind may not only improve access to care, but may also promote patient inclusivity in research studying post-surgical outcomes 41 .…”

Section: Secure and Equitable Accessmentioning

confidence: 99%

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The role of digital technology in surgical home hospital programs

2023

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Home hospital (HH), a care delivery model of providing hospital-grade care to patients in their homes, has become increasingly common in medical settings, though surgical uptake has been limited. HH programs have been shown to be safe and effective in a variety of medical contexts, with increased usage of this care pathway during the COVID-19 pandemic. Though surgical patients have unique clinical considerations, surgical Home Hospital (SHH) programs may have important benefits for this population. Various technologies exist for the delivery of hospital care in the home, such as clinical risk prediction models and remote patient monitoring platforms. Here, we use institutional experiences at Brigham and Women’s Hospital (BWH) to discuss the utility of technology in enabling SHH programs and highlight current limitations. Additionally, we comment on the importance of data interoperability, access for all patients, and clinical workflow design in successfully implementing SHH programs.

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Section: Secure and Equitable Accessmentioning

confidence: 99%

Section: Secure and Equitable Accessmentioning

confidence: 99%

The role of digital technology in surgical home hospital programs

2023

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“…Compared with traditional hospital care, patient and family care experience is better, while complications and costs are lower. [3][4][5][6][7][8][9][10] Despite such benefits, prior to COVID-19 HaH programs were not widely implemented in the US, largely due to lack of fee-for-service Medicare reimbursement and regulatory limitations. 11,12 Key points…”

Section: Introductionmentioning

confidence: 99%

A national qualitative study of Hospital‐at‐Home implementation under the CMS Acute Hospital Care at Home waiver

Gorbenko

Baim-Lance

Franzosa

et al. 2022

J American Geriatrics Society

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Background The Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) waiver program in November 2020 to help expand hospital capacity to cope with the COVID‐19 pandemic. The AHCaH waived the 24/7 on‐site nursing requirement and enabled hospitals to obtain full hospital‐level diagnosis‐related group (DRG) reimbursement for providing Hospital‐at‐Home (HaH) care. This study sought to describe AHCaH implementation processes and strategies at the national level and identify challenges and facilitators to launching or adapting a HaH to meet waiver requirements. Methods We conducted semi‐structured interviews to explore barriers and facilitators of HaH implementation. The analysis was informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework. Interviews were audio recorded for transcription and thematic coding. Principal Findings We interviewed a sample of clinical leaders (N = 18; clinical/medical directors, operational and program managers) from 14 new and pre‐existing U.S. HaH programs diverse by size, urbanicity, and geography. Participants were enthusiastic about the AHCaH waiver. Participants described barriers and facilitators at planning and implementation stages within three overarching themes influencing waiver program implementation: 1) institutional value and assets; 2) program components, such as electronic health records, vendors, pharmacy, and patient monitoring; and 3) patient enrollment, including eligibility and geographic limits. Conclusions Implementation of AHCaH waiver is a complex process that requires building components in compliance with the requirements to extend the hospital into the home, in coordination with internal and external partners. The study identified barriers that potential adopters and proponents should consider alongside the strategies that some organizations have found useful. Clarity regarding the waiver's future may expedite HaH model dissemination and ensure longevity of this valuable model of care delivery.

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“…4 Another recent study concluded that the hospital-at-home paradigm may be effectively applied to patients who are economically disadvantaged and not disadvantaged. 5 However, not until the public health emergency wrought by the COVID-19 pandemic did hospital-level home-based care expand unabated.…”

mentioning

confidence: 99%

“…In 1978, a randomized clinical trial of home vs hospital case management was conducted . A more recent randomized clinical trial of hospital-level care at home for acutely ill adults concluded that “home patients had better experiences with their care team, had more experiences promoting healing such as better sleep and physical activity, and had better experiences with systems factors such as the admission processes.” Another recent study concluded that the hospital-at-home paradigm may be effectively applied to patients who are economically disadvantaged and not disadvantaged . However, not until the public health emergency wrought by the COVID-19 pandemic did hospital-level home-based care expand unabated.…”

mentioning

confidence: 99%