The acute hospital at home (HaH) program is a healthcare model where patients receive acute care services in their homes rather than in a traditional hospital setting. The concept of HaH has evolved, driven by advancements in medical technology, changes in healthcare delivery models, and a focus on patient-centered care. Acute hospital at home programs combined with remote patient monitoring (RPM) expand patient care and eligibility, enhance safety, and reduce costs.
This article will examine how HaH and RPM expand patient eligibility, enhance safety measures, and drive operational efficiencies. We will discuss the potential for cost reduction, improved patient outcomes, and extending high-quality care beyond traditional hospital settings.
Acute Hospital at Home History
Regular vital signs monitoring is routine in hospital inpatient care. Continued monitoring is sometimes required after discharge in the home. These hospital at home programs were conceived in the 1990s and address acute and chronic medical conditions, including heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and post-surgical recovery.
The Centers for Medicare and Medicaid Services (CMS) introduced the Acute Hospital Care at Home waiver during the COVID-19 pandemic primarily to address hospital capacity issues. The model also addresses parity with inpatient care reimbursement. As a result, over 250 hospitals and health systems are building or expanding their hospital-level care at home.
Remote Patient Monitoring in Acute Care
Remote patient monitoring is now routinely used to manage chronic conditions. However, its potential in the acute hospital at home model has yet to be fully realized. RPM uses remote patient monitoring devices that collect vital sign data. This health data is transmitted to the clinical team for analysis and decision-making.
A recent study noted that extending the care continuum into patients’ homes with hospital at home programs yields favorable outcomes and cost savings compared to traditional inpatient care. This integration also opens up opportunities for patient eligibility, safety, and operational efficiency. The following sections explore the potential benefits of combining HaH and remote patient monitoring.
Patient Eligibility
Acute hospital at home programs traditionally served patients in urban settings. With RPM, eligibility is significantly expanded to include patients with moderate-acuity medical conditions. For instance, continuous single-lead electrocardiogram (ECG) monitoring could extend acute hospital at home services to patients with heart failure.
This is significant as heart failure is one of the leading causes of hospitalizations. RPM also has the potential to make hospital at home programs economically viable in suburban and rural areas by replacing some in-person evaluations with telehealth consultations.
Patient Safety
Despite the safety advantages of acute hospital at home care, there is room for enhancement. According to research, RPM can mitigate the risk of hospital-acquired infections, decrease delirium rates, and minimize the impact of post-hospital syndrome. Fall detection RPM can be particularly instrumental in reducing hospital events. By continuously monitoring patients at risk of falling, acute hospital at home programs are an intervention to enhance patient safety.
Operational Efficiency and Lower Healthcare Costs
Remote patient monitoring enables acute hospital at home programs to care for a larger patient population and helps optimize operational efficiency. Costs are reduced by replacing in-person evaluations with remote patient monitoring nurse assessments. Moreover, integrating RPM into the care continuum after discharge can reduce hospital readmissions and healthcare costs.
A pilot study by Harvard-affiliated Brigham and Women’s Hospital found an average cost reduction of 30% per eligible acute hospital care at home encounter, or approximately $3,000 per encounter. This resulted in over $1 million in savings per hospital, demonstrating the delivery of higher-quality and more efficient care.
Understanding Acute Hospital at Home Care and Remote Patient Monitoring
Combining remote patient monitoring with acute hospital care at home presents some challenges and considerations. Critical aspects include striking the right balance in monitoring modality and frequency, mitigating false alarms, and ensuring device reliability. Research and knowledge-sharing among early adopters and collaboration between clinicians, software experts, and policy support will be key to realizing RPM’s full potential in at-home care.
HaH and remote patient monitoring combined can make patient care more patient-centric, cost-effective, and safe. Embracing these innovations, backed by rigorous research and operational insights, is imperative in a new era of healthcare. The journey from hospital to home is evolving, and remote patient monitoring is paving the way for a brighter, more patient-focused future.
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