Virtual hospital-level care—feasibility, acceptability, safety and impact of a pilot Hospital-In-The-Home model for COVID-19 infection

Lawrence, Joanna; Truong, D.; Dao, A.; Bryant, Penelope A

doi:10.3389/fdgth.2023.1068444

Cited by 6 publications

References 15 publications

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Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Gothot,

Maniaci,

Paulson

et al. 2024

J Patient Saf

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Objectives Mayo Clinic’s hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting. Methods Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates. Results Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups. Conclusions Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.

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Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Gothot,

Maniaci,

Paulson

et al. 2024

J Patient Saf

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Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home)

Melman,

Teng,

Coombs

et al. 2024

Emerg Medicine Australasia

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ObjectivesLow back pain was the sixth most common reason for an ED visit in 2022–2023 in Australia, one‐third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes.MethodsEthics approval was granted for protocols X21‐0278 & 2021/ETH10967 and X21‐0094 & 2021/ETH00591. We conducted a mixed‐method process evaluation, using the RE‐AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.ResultsThis preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724–AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.ConclusionsPreliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non‐serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

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Potential bed-day savings and caregiver perspectives of transitioning hospital-level management of infants with bronchiolitis to the home: a mixed-methods study

Lawrence,

Hiscock,

Bryant

et al. 2024

Arch Dis Child

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ObjectiveHome management of infants admitted to hospital with bronchiolitis would alleviate pressure on hospital beds. We aim to understand the proportion of children requiring active care interventions (ie, oxygen, fluids), caregiver perspectives and potential impact of transitioning hospital-level care of infants with bronchiolitis to home.MethodsThis is a mixed-methods study in an Australian tertiary paediatric hospital. Semistructured interviews with caregivers of infants with bronchiolitis focused on attitudes towards managing bronchiolitis at home. Interviews were analysed using inductive thematic analysis. Data on bronchiolitis admissions among infants aged 1–12 months were extracted from the electronic medical record from April 2016 to October 2020. Potential bed-days saved were calculated.Results18 parents were interviewed, with themes emerging of ‘hospital is safe’, ‘hospital incurs costs’ and ‘knowledge is power’. During 4.5 years, 2367 infants were admitted to hospital with bronchiolitis: a total of 4557 bed-days. Of these, 40% of infants were admitted for monitoring alone, 25% for nasogastric fluid support, 17% for oxygen therapy and 7.5% for both fluids and oxygen. 11% received treatments not currently feasible at home (high-flow oxygen, intravenous fluids). Oxygen therapy accounted for the largest number of bed-days (242 bed-days/year).ConclusionManaging bronchiolitis at home could have a substantial impact on hospital bed demand, with an estimated 344 bed-days saved per year if all interventions were offered. Parent willingness to transfer to home balances the perceived safety of the hospital versus the financial, logistic and emotional costs. Empowering parents with knowledge was seen as a substantial facilitator of supporting transition to the home.

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Virtual hospital-level care—feasibility, acceptability, safety and impact of a pilot Hospital-In-The-Home model for COVID-19 infection

Cited by 6 publications

References 15 publications

Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home)

Potential bed-day savings and caregiver perspectives of transitioning hospital-level management of infants with bronchiolitis to the home: a mixed-methods study

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