Providing advanced hospital care at home

Abstract

A 72-year-old man with acute kidney injury and pyelonephritis. A 68-year-old woman with saddle embolus and hyperglycemia. An 82-year-old woman with pneumonia and COPD exacerbation. A 74-year-old man with lower extremity cellulitis. A 74-yearold man with acute kidney injury, decompensated heart failure, hyponatremia, and hyperglycemia.What do all of these patients have in common? They were enrolled and successfully managed in a reduced length-of-stay (LOS) home hospital program after spending 1 to 2 days in a traditional hospital setting. Although this concept may not be new, the pandemic has shed light on the utility of alternative care pathways. Given the regulatory news released by the Centers for Medicare and Medicaid Services (CMS) in late 2020, this represents not only opportunity for innovation in healthcare delivery but also an important niche for PAs and NPs. CMS has implemented a waiver and is now allowing patients to be admitted to home from the ED or an inpatient bed before their second midnight; nearly 60 diagnostic-related groups (DRGs) are considered safe to monitor and treat at home under the direction of a physician. 1 This model has been implemented over the years in various markets across the country and overseas, all documenting various levels of success. [1][2][3][4][5] This model of care is aimed at either an acute hospital substitution model, admitting patients from the ED, or as a reduced LOS ABSTRACT Interest is growing in hospital-at-home as a model of patient care. Given the pandemic, various entities are exploring methods to deliver hospital-level care in nontraditional settings to clinically stable patients with adequate home support.