Affiliation:
1. Care New England Health System and Integra Community Care Network Providence Rhode Island USA
2. Department of Medicine Division of Geriatrics and Palliative Care Brown University Providence Rhode Island USA
3. Roger Williams Medical Center Providence Rhode Island USA
4. Providence Veteran's Administration Medical Center Providence Rhode Island USA
5. West Health Institute La Jolla California USA
Abstract
AbstractBackgroundAs individuals age, they may need new strategies to manage exacerbations of chronic disease to maintain their dignity and independence. Many end up in a revolving cycle of emergency department visits, hospitalizations, and post‐acute care. Support to stay at home, which is often their preference, becomes a challenge and varies with insurance coverage, location, and financial status. There are few home‐based options sufficiently agile enough to respond when acute conditions arise particularly with exacerbations of chronic disease.MethodsIn 2018, Integra designed a home‐based option to treat acute exacerbations of chronic illness. A partnership with community paramedicine enabled faster response times and provided additional treatment tools. Using process improvement methodology, we developed “Integra at Home” workflows and team‐based care. We counted averted emergency visits and hospitalizations, patient and staff satisfaction, and evidence of financial sustainability as a result of our program.ResultsIntegra successfully developed a suite of home‐based services, including responses to acute problems, to address beneficiaries' fluctuating medical needs. Following responses to 415 acute events, 74% (N = 307) resulted in averted emergency department visits. Based on InterQual® criteria, 34% (N = 103) of averted visits would have qualified as an averted hospitalization. All 64 respondents to patient surveys (N = 170) stated they would recommend our program. The staff indicated the model is a better way of caring for patients with higher rewards than traditional settings. The average length of stay in hospice for patients referred from the program (N = 22) was 4 weeks.ConclusionsHome‐based care continuums are feasible, yet resources to manage acute exacerbations remain inadequate. To fill this gap, we created higher acuity services to respond to urgent needs and monitor symptoms between episodes. Amid successes and challenges, we are serving higher acuity older adults in Integra's home‐based continuum model. We encourage further spread of longitudinal home‐based acute care models.
Subject
Geriatrics and Gerontology
Reference9 articles.
1. 2021 Home and Community Preference Survey: A National Survey of Adults Age 18-Plus
2. New England Journal of Medicine Catalyst. Innovations in Care Delivery: what is value‐based healthcare?NEJM Catalyst. January 1 2017. Accessed March 14. 2023.https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558
3. RoilandR McClellanM HigginsA.High‐Value Comprehensive Care for Individuals Families and Communities: A Vision and Strategy for the Centers for Medicare and Medicaid Services In Collaboration with States Payers and Purchasers. June 10 2021. Accessed March 13 2023.https://healthpolicy.duke.edu/publications/high-value-comprehensive-care-individuals-families-and-communities-vision-and-strategy
4. Timing of Hospice Referral