@article{26052d694c674aed8dab7bdd0fdd8f10,
title = "Hospital at Home-Plus: A Platform of Facility-Based Care",
abstract = "OBJECTIVES: To describe the evolution of a hospital at home (HaH) program to a HaH with a 30-day posthospitalization transition period (HaH-Plus) and results of a retrospective review of cases. DESIGN: After launching HaH-Plus, we used the same interdisciplinary clinical team to provide acute home-based care for a broader range of home-based acute-level services than originally conceived in the Hospital at Home model. These included a palliative care unit at home (PCUaH), an observation unit at home (OUaH), a post-acute care rehabilitation at home (RaH), and a program for the hospital averse – those patients needing to be in the hospital but who refuse. SETTING: Urban health system. PARTICIPANTS: Individuals 18 years or older residing in specified catchment area with Medicare fee-for-service or accepted Medicare/Medicaid Advantage plans requiring facility-based care. INTERVENTION: Provision of facility-based acute-level care at home to 685 participants. MEASUREMENTS: Length of stay, readmission, and mortality. RESULTS: HaH-Plus cared for 685 individuals. The PCUaH had the oldest participants (mean age 87), and all groups were predominantly female and dually eligible for Medicare and Medicaid. Diagnoses and length of stay were similar in all groups except that those in RaH had a larger group of diagnoses, than those accepted in to HaH-Plus and those in OUaH had a shorter stay. Rate of readmission was highest for RaH (19%). Mortality during the active treatment episode was highest for PCUaH and hospital averse as compared to HaH-Plus, OUaH and RaH. CONCLUSION: Providing a broader range of facility-based care in the home has significant advantages for patients and increases the scalability of HaH. Developing a spectrum of services was possible by leveraging a robust, 24-hour HaH team. Community- and home-based care could become a greater part of the U.S. healthcare system if a platform of HaH services along with advances in technology and payment models were developed. J Am Geriatr Soc 67:596–602, 2019.",
keywords = "home-based medical care, hospital at home, postacute care",
author = "DeCherrie, {Linda V.} and Ania Wajnberg and Tacara Soones and Christian Escobar and Elisse Catalan and Sara Lubetsky and Bruce Leff and Alex Federman and Albert Siu",
note = "Funding Information: Financial Disclosure: Research reported in this publication was supported by the National Institute on Aging Claude D. Pepper Older Americans Independence Center (TS, 3P30AG028741), and the John A. Hartford Foundation. The Mobile Acute Care Team hospital-at-home clinical project described was supported by Grant 1C1CMS331334 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented was conducted by the awardee. Findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor. Funding Information: Barbara Morano, Joanna Jimenez-Mejia, Theresa Soriano, Cameron Hernandez, Ramiro Jervis, Janeen Marshall, Gabe Silversmith. Financial Disclosure: Research reported in this publication was supported by the National Institute on Aging Claude D. Pepper Older Americans Independence Center (TS, 3P30AG028741), and the John A. Hartford Foundation. The Mobile Acute Care Team hospital-at-home clinical project described was supported by Grant 1C1CMS331334 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented was conducted by the awardee. Findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor. Conflict of Interest: Dr. Leff is a consultant for Medically Home and DispatchHealth. Dr. DeCherrie, Dr. Wajnberg, Dr. Escobar, Dr. Federman, Dr. Siu, Ms. Catalan, and Ms. Lubetsky are full-time employees of the Icahn School of Medicine, which has an ownership interest in a joint venture with Contessa Health, a venture that manages acute care services provided to people in their homes through prospective bundled payment arrangements. These persons have no personal financial interest in the joint venture. Author Contributions: DeCherrie, Escobar, Leff: study concept and design, analysis and interpretation of data, preparation of manuscript. Wajnberg: study concept and design, preparation of manuscript. Soones: study concept and design; acquisition, analysis, and interpretation of data; preparation of manuscript. Catalan, Lubetsky: data collection, analysis and interpretation of data, preparation of manuscript. Federman, Siu: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Sponsor's Role: The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2018 The American Geriatrics Society",
year = "2019",
month = mar,
doi = "10.1111/jgs.15653",
language = "English (US)",
volume = "67",
pages = "596--602",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",
}