One day in the near future, a geriatric patient might show up atPenrose Hospital's emergency room with symptoms so serious that heshould, by all measures, be admitted immediately. At that point, thestaff will call an ambulance and send him home.
Is this an example of serious flaws in the health-care system? Acase of callous mismanagement?
To Erin Denholm, it may be the future of hospital care forpatients with chronic, though not life-threatening, conditions.Denholm is president and CEO of Centura Health at Home, and shepicked Centura's hospital system in Colorado Springs to pilot aHospital at Home program, a small but slowly growing model oftreating patients that is proven to improve their outcomes, cuttheir risks and reduce costs. It would be the first Coloradohospital to try Hospital at Home.
'The outcomes are just fantastic,' Denholm says.
Of course, patients won't be sent home just to be ignored.Denholm said a nurse will meet them at home when they leave thehospital. Doctors and other medical staff will make regular visitsand assure the patient's needs are met. And, in a twist that may beunique to the model, Centura will integrate its Hospital at Homewith its 8-year-old telehealth program, which uses an in-homemonitoring station, similar to a laptop, to take a patient's vitalsigns and upload them to a nurse at another location.
Dr. Bruce Leff, a geriatrician, researcher and professor ofmedicine at Johns Hopkins University School of Medicine, begandeveloping the Hospital at Home concept in 1994 after noticing thata lot of acutely ill older adults didn't want to be in the hospital,or that their cognitive health would decline if they werehospitalized. Small studies on the program were done at Hopkins, andlarger ones followed when some VA hospitals adopted the program.
'This is a very well studied intervention,' said Leff, who was inColorado Springs on Wednesday to work on the program with Centura.'There have been dozens of randomized controlled trials.'
The studies show a 38 percent reduction in mortality at sixmonths for someone who is sent directly home from an emergency roominstead of being admitted to the hospital.
'As far as I know, there are no meds that can give that kind ofoutcome,' he said.
Denholm said there are other documented benefits to treatingqualifying patients at home.
'We see decreased infection rates when people are in their ownhome, but the most intriguing thing is, the use of pain medicationsdecreases in dose and frequency when they're at home,' she said.'There also is improved recovery time and decreased episodes ofdelirium.'
Cost-wise, she said, it can save patients thousands of dollarsbecause they don't have to pay for room, board and food at thehospital. Telehealth will only increase the savings, she said. Leffsaid patients also save because they won't get unnecessary tests, asthey might if they were hospitalized.
'What happens is when they get admitted, they gets lots of testsbecause they're close to the technology,' Leff said.
The program isn't for everyone, said Leff. People having heartattacks or needing intensive care treatment wouldn't be consideredfor it. It was formulated with geriatric patients with chronicailments, such as COPD, pneumonia and heart failure, who wereexperiencing acute symptoms from their disease.
It's expanded to include patients with other conditions,including pulmonary embolisms and complicated urinary tractinfections, and Leff said it could be used for any population - notjust seniors - if medical reimbursement were not an issue.
Regular Medicare and private insurance operate on a fee-for-service basis, a disincentive for hospitals to participate in aHospital at Home program.
'If you're in a fee-for-service environment, the conversation ispretty short,' Leff said. 'If you're not in a managed care setting,then the hospital - which creates revenue by admitting patients -has no incentive to admit someone to their home when there's noreimbursement.'
Centura chose the Penrose-St. Francis Health Services system forits Hospital at Home tryout because it participates inUnitedHealthcare's Secure Horizons Medicare Advantage plan. BothCentura hospitals in the Springs will participate. Secure Horizonsis what is known as a 'capitated' plan, meaning it pays the system aper-member lump sum of money every month, rather than a fee for eachservice the hospital provides. About 9,000 people are enrolled inthe plan, so they'll be the only ones eligible to take part inHospital at Home.
Denholm hopes that Hospital at Home will be ready to take on itsfirst patient by September. It won't need extra staff, she said, butwill involve 'repurposing' some roles. Once it's been tested and, ifneeded, tweaked, it would expand to Centura's other hospitals.
Denholm emphasizes that it will be a patient's choice toparticipate, but she doesn't expect much of a cold shoulder fromthose who are eligible.
'A lot of people would prefer to be at home,' she said.
