How Hospital at Home Can Improve Patient Outcomes
Hospital-level care in the home has gained popularity in the United States following a surge in health systems building programs to provide this care delivery option during the COVID-19 pandemic. Already widely in use in some healthcare systems overseas, these hospital-at-home programs have a proven track record of improved patient outcomes. In the past handful of years, increasing evidence has shown that these positive outcomes have continued with adoption of care at home in the United States.
Hospital systems and payers searching for ways to improve value-based outcomes may be interested in adding novel approaches to care that increase patient satisfaction and positive outcomes. When considering the introduction of high-quality medical care in the home, an important question to ask is “why does bringing the continuum of care to patient’s homes help improve outcomes?”
Positive patient outcomes observed in hospital-at-home and other healthcare at home offerings include reduced readmission rates and length of stay, fewer complications of care such as pressure ulcers and falls, and improved patient satisfaction. The unique nature of care in the home contributes to these measurable improvements in several ways. Let’s take a closer look.
Outcomes at home vs. the hospital
One of the most vulnerable moments in our lifetimes is being admitted to the hospital. It’s easy for a healthcare provider to see hospital-level care as routine, but the patient’s experience is often anything but routine. Patients are suddenly in an unfamiliar and uncomfortable environment, navigating their needs with people they may have just met and often separated from family and other loved ones.
This vulnerability can increase anxiety for patients, at a time when physically and emotionally they may be even less equipped to manage it. Increased anxiety, embarrassment, loss of autonomy, privacy, fear of medical procedures and difficulty making decisions can all play a role in patients withdrawing from or even openly resisting participating in care.
For most patients, home is a comfortable and familiar environment that decreases this sense of vulnerability and increases independence and access to support from trusted family and friends. In this context, we find that it is often easier to collaborate with patients to support better care outcomes. They are more relaxed and more likely to participate in their care and in developing their treatment goals. Additionally, when their support network is actively involved in promoting their success, patients may have more accountability to follow through on these goals of care.
The importance of patient autonomy and control
As we’ve pointed out, patients who can participate in their own care generally do better. Another way the home removes barriers to patient participation in care is by creating more of a focus on patient autonomy and control. In the hospital, doctors, advance practice providers and nurses drive the plan of action.
The nature of hospital care means that things like drawing bloodwork or obtaining vital signs are done at set intervals, often designed out of necessity around staff workflows and availability, not each patient’s typical routine. Noise levels are sometimes dictated by circumstances out of a patient’s control, and sleep is often disrupted. Healthcare personnel will unexpectedly enter a patient’s room, often with little predictability.
At home, the patient flips the script. They are living their own routine and healthcare personnel are coming into their world. They sleep in their own bed, eat familiar foods, use the bathroom when they choose and move about freely with access to activities they enjoy. This increased mobility and interaction with the home environment can help patients regain strength and avoid deconditioning. And for obvious reasons, it usually increases patient satisfaction as well.
Better participation in care leads to better transitions of care
Increased autonomy and control over their own circumstances and care can help patients feel a greater sense of ownership over their goals of care. In contrast, patients admitted to the hospital often release their autonomy to a care team with the expectation “they will make me better.”
Taking away autonomy only reinforces the subconscious idea that getting better isn’t up to them. For example, there are limitations in how the patient can participate in their own care, such as staff being strictly responsible for medication administration and tasks like monitoring blood sugar or even going to the bathroom.
At home, the patient is expected to participate in care more, with the support and direction of their care team. This shared ownership encourages patients to say, “I want to make myself better, and I’m going to own this outcome.”
With this approach, patients are given the skills they need to successfully execute their own care after discharge from the program. Not only does this change the way they receive information about their care, but also how well they retain the information and understand what they need to do to maintain their health.
Additionally, robust care coordination in the home ensures the patient has the right follow-up information and appointments with their primary care provider or specialists. It can also connect them with other case managers going forward so they continue to have support in planning their care.
Better understanding on the part of the patient, paired with clear “next steps,” often results in smoother transitions of care and significantly better outcomes for both patients and the hospital system and payers involved in their care.
Furthermore, a full continuum of care in the home reduces the number of care transitions needed to effectively address complex health conditions. In an ideal setup, a patient can be admitted through a hospital at home program, connected to palliative care in the home, offered home health services and more all through the same organization with end-to-end care coordination.
Health literacy and social determinants of health
Another way that care at home has an impact on better outcomes is through social determinants of health (SDOH). The most obvious components of SDOH are things like socioeconomic status and access to food and medical care—questions that are often asked during patient screenings in the hospital. But it’s much more difficult to pick up on subtle factors through a medical record than it is in a patient’s home.
Providers can learn more about the patient in their home
In the home, we can see less obvious components of SDOH. What is the patient’s health literacy and how well do they understand their medical conditions? What is their family and caregiver support? Are they experiencing isolation and loneliness? How much do they participate in their care, and are they having difficulty making it to doctor’s appointments or taking their medications correctly?
These factors can have a profound impact on patient outcomes. For example, the impacts of loneliness and isolation on health have been extensively studied. One meta-analysis published in the BMJ Journal Heart showed social isolation results in an increased risk of developing coronary heart disease or stroke, much like smoking.
Nurses spend more time with patients in this care model
By going to patients’ homes, spending more time with them and understanding them in a new way, providers have an opportunity for creating more impactful relationships with their patients. It’s something that can be missed entirely and never addressed in traditional inpatient care. But in the home, providers are more aware of these factors affecting their patients’ well-being, and can collaborate with the patient, their family and the larger care team and community to solve for a better outcome.
This is easy to see when we look at the time nurses spend each day with their patients in this model. With twice daily visits that can last up to 90 minutes each depending on the patient’s needs, patients enjoy dedicated one-on-one time with their nurses that exceeds sometimes brief hospital encounters. It’s one of the reasons we see increased job retention and satisfaction from our nursing staff as well.
The same is true for virtual visits with physicians, which can be as much as 20-30 minutes long, contributing further to high patient satisfaction ratings and provider job satisfaction as well.
Patients better understand how to take care of their health concerns at home
Outside of the hospital, patients spend much of their time managing their health concerns at home. It is in this context that they are often best prepared to understand the best ways to be involved in their own care.
Again, social determinants of health viewed in real-time play a role in this outcome. The U.S. Department of Health and Human Services described in detail in a recent report how several key factors impact health outcomes. These key factors include things like health and safety risks in homes, access to transportation (and subsequent outpatient care) and care coordination. By bringing care to the patient, we ensure they have a deeper understanding of their health, remove barriers to continued success and help them interact with their environment in ways that improve health equity and outcomes.
Better outcomes at home are the standard of care
Altogether, the many ways in which care in the home positively impact patient outcomes are catching the attention of health systems and payers. For a subset of patients that meet criteria for safe care at home, it truly has the potential to become the standard of care going forward. This is an exciting new frontier in healthcare that Contessa’s models are uniquely positioned to support. To learn more, email firstname.lastname@example.org or see our website at www.contessahealth.com.