Improving the Art and Science of Medicine Through Hospital at Home

When asked what it’s like to practice advanced care at home, providers delivering care in hospital-at-home models often repeat a common theme: “it has brought back the art and science of medicine in my practice.” 

In many ways, delivering care at home is not a novel concept. As recently as 1930, as much as 40% of provider-patient encounters took place in the form of house calls. By 1980, that number was less than 1%. 

In the modern era, the COVID-19 pandemic has spurred a renewal of in-home visits, albeit via a surge in telehealth. This includes novel approaches to even high-acuity care in the home. Ever since the public health emergency made funds available for creating hospital beds outside the four walls of the hospital, hospital-at-home care has begun to grow exponentially. It’s in this context that we see a whole new perspective on the practice of medicine, improving the art and science of care delivery. 

A different lens in the home 

In the home, nurses have the advantage of being able to directly view the impact of the home environment on the patient, to carefully assess the medications present in the home, the caregiver dynamics, and to see how social determinants of health might impact outcomes.  

Providers, as well, can more easily understand the factors impacting patients’ recovery. A daily evaluation of progress toward the goals of care often reveals barriers that aren’t visible within the four walls of the hospital, where insight is limited to what patients might describe, but not what a care team in the home can observe in real-time.  

Often, we’re able to notice challenges like health literacy, dietary intake, caregiver dynamics and compromised safety in the home, and then correct them by providing support such as patient education and community resources. It emphasizes the patient as a person, not a diagnosis. 

Elements of care strengthened

The nature of this approach to care delivery means that many elements of patient care are stronger in the home, including team collaboration, patient and caregiver involvement in the plan of care, patient education and long-term care planning. 

Better team collaboration at home 

In the hospital environment, various tools exist to support a team approach to care. This is often a combination of notes and shared data in the electronic health record (EHR), whiteboards in patient rooms and efforts to ensure team rounding where providers, nurses and other clinicians align for a plan of care. The reality of the high-volume, fast-paced hospital often means that gaps in communication inevitably happen. 

In the home, each day is a chance for providers and nurses to meet one-on-one about the patient’s plan of care, discuss any ongoing barriers to recovery and understand what is happening for the patient. Because it is a more focused approach, it creates better communication, less clinical uncertainty and potentially unnecessary care, and improved patient outcomes.  

Better patient and caregiver involvement at home

This same daily cadence to collaborative care allows patients and caregivers the opportunity to sync with the broader care team. In contrast, in the hospital environment it can be challenging to align meetings without scheduled visits (as is possible in hospital at home), and this is particularly true for caregivers, who often are not at the hospital 24/7. 

How providers develop new skills in the home

Providers conditioned to practice medicine in the hospital are used to relying on a resource rich environment to guide their care planning. We’re able to bring many of the resources found in the hospital direct to patients’ homes: intravenous (IV) medications, blood draws for lab analysis, DME and even echocardiograms and ultrasound. However, the “easy” option of hospital logistics is less direct.  

This leads to a shift in the way providers practice. To get more details, more time must be spent listening carefully to patient stories. Then, providers must be thoughtful, taking the time to carefully consider what they have learned. What did the physical exam look like? What is the nurse reporting about their findings? How does the patient’s story fit into the bigger picture, and what is at the provider’s disposal in the home to uncover more details?  

New insights for providers in the hospital 

After caring for patients in the home, providers show improved critical thinking, proactive medical decision making, and create smoother transitions of care. It’s easier to understand how patients in the hospital are at home, which has a big impact on how they treat and care for patients. With the experience in patient’s homes, what happens post-discharge is no longer a concept, but a concrete reality. It results in less frivolous care and shorter hospital lengths of stay. 

A new era of house calls 

In the context of advanced healthcare in the home, we are beginning to see how a new, modern era of house calls is transforming the practice of medicine and helping providers refine the art of delivering personalized care that treats the whole patient. This includes care that can change long-term outcomes by helping to build a home environment where patients can succeed in managing chronic conditions.  

The results so far are compelling: improved outcomes, minimal to zero complications of care and improved patient satisfaction ratings. As more studies bear out this approach, we will be able to define benchmarks that reflect all the positive impacts of bringing care home, including metrics like decreased readmission rates, increased healthy literacy and reduced length of stay. 

These gains will be further aided by expanding the continuum of care in the home, something we are doing at Contessa with Comprehensive Care at Home, by going beyond just hospital-at-home care to include Rehabilitation Care at Home, in lieu of skilled nursing facility placement and Palliative Care at Home for those with complex, chronic illness. As the models of care in the home continue to expand, this new era of house calls will reinvent many of the ways in which medicine is delivered, for the better.