Hospitals Making House Calls
It had been a tough two weeks in the hospital for the young woman from Michigan. For a full week before she went to the hospital her family had begged her to go. After she couldn’t keep down food or liquids for a week, enough was enough. Despite her worry that she’d catch COVID-19, her sister loaded her up in their car and brought her to the emergency room. The doctors told her that had she waited another few days week, she might have lost her kidney function permanently.
Now, things were on the upswing, but she was not yet well. A few years ago, the standard treatment would have required another week in the hospital hooked up to an IV, unable to sleep, unable to have her sister visit because of COVID precautions, and constantly worried she would get infected after all.
Instead, she was sent home – where she received top-flight care thanks to visiting nurses and portable IV devices.
The woman was part of a revolution in care. Today, it’s not just doctors who are making house calls, it’s also the hospital.
Advances in technology are enabling caregivers to provide a broad array of high quality health services to acutely ill patients where they live. This new model has been shown to significantly reduce costs while improving health outcomes.
As a result, it promises to be one of the most fundamental transformations of medicine in decades.
Ironically, this revolution in care, which is still in its infancy, has been born in part because of the deadly plague of COVID-19, which continues as we now battle the Delta variant.
Since it emerged with force in March 2020, COVID-19 created significant space and resource issues for hospitals, which typically operate close to capacity. The sudden influx of desperately ill patients forced us to make hard choices, delaying many procedures that were necessary but not immediately essential – such as knee and hip replacements.
This experience prompted many hospitals to question old assumptions about maximizing quality care with limited resources. Across medical specialties, for example, telemedicine use increased dramatically, due to the difficulty of scheduling face-to-face appointments throughout the pandemic.
The health care system I lead, Michigan Medicine, held 444 virtual appointments in February 2020, the month before COVID-19 struck with force. Now, we hold more than 34,000 virtual visits each month.
In-home hospital care is also promising. Wireless devices now allow doctors to continuously monitor a wide range of vital signs, such as temperature, heart rate, respiratory rate and movement in real time. The development of new equipment – including infusion pumps, respiratory therapies, point-of-care blood diagnostics – allows important aspects of treatment to be provided at home.
These advances, combined with in-person and virtual house calls by doctors, nurses and other caregivers, ensure a high level of care.
A study conducted at Boston’s Brigham and Women’s Hospital and published in the Annals of Internal Medicine in 2019 confirmed earlier studies about cost savings, reporting that the cost of acute care episodes was about 35 to 40 percent lower for home patients versus the control group treated at the hospital.
Most significant, the study found that home patients were less likely to be readmitted within 30 days of discharge. Some of this benefit, the authors note, is because the patients were “surrounded by their family and friends, [could] eat their own food, move around in their own home, and sleep in their own bed (without being awakened multiple times per night) all with the support of the home hospital team.”
This was the case with the young woman whose recovering kidneys were treated at home with home care by our physicians and nurses. While treating her immediate health issues, the caregivers were also identified health literacy issues and many other social determinants of health factors that affected her ability to care for herself that we are now working with her to resolve.
While it is extremely promising, home hospital care is more of an idea than a fully developed model. More research must be conducted to firmly establish its benefits and drawbacks. Only a small subset of patients with specific conditions has been included in studies conducted so far; it could, for example, offer significant improvement for pediatric care.
In addition, a workable payment system needs to be developed with the federal government and insurers to ensure that the most effective financial incentives are in place for patients.
But as health care costs continue to rise and hospitals space and resources are coming under increasing pressure even when the system is not stressed by unanticipated tragedies such as COVID-19, the in-home approach is a promising new way to help caregivers deliver on our timeless goal of delivering the right care at the right place, time and cost.
Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan. He serves on the Board of Directors for Eli Lilly and Company.
