Home-Based Care is care a patient receives in the comfort of their own home instead of in a hospital, urgent care center, or a provider’s office. This program is targeted to help older patients with high emergency and in-patient utilization. Older adults presenting to the emergency department (ED) are admitted at almost four times the rate of the general population. Nearly 70% of hospital admissions for patients aged 65 and older originate in the ED.
Advancements in technology and cutting-edge treatments allow clinicians to care for patients in their own homes with the same capability as an in-office visit or hospital stay. Technology that once was only available in the acute setting, such as continuous vital sign monitoring, can be brought into the patient’s home for Home Hospital patients. Diagnostic testing such as chest x-rays and ultrasound can be used in the home by a mobile urgent care nurse practitioners (NPs).
Partners Home-Based programs treat a variety of conditions that can be safely and effectively treated in the home including: infections such as cellulitis, heart failure and COPD exacerbations. Patients are highly satisfied with their care and Partners continues to expand access to home-based care offerings.
Until recently, the standard for acute care has been associated with hospital-based services. While inpatient hospitalization continues to offer high quality patient care, a new option has emerged providing clinically-advanced, cutting edge inpatient level of medical treatment at home. Launched in 2017 at Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH), the Home Hospital program offers an alternative to inpatient acute hospital care. For selected acutely ill patients, Home Hospital provides a less expensive, and often safer, option to inpatient care. Patients are now able to receive an inpatient level of care while remaining in the comfort of their own homes, avoiding exposure to hospital-acquired infections, and maintaining their functional status and mobility.
Since 2017, the Home Hospital program has treated over 250 patients in their home. At a minimum, patients receive once daily visits from a physician or nurse practitioner (NP), and twice daily visits from a registered nurse (RN). Physical or occupational therapy, social work, and home health aid visits are provided on an as-needed basis. Selected outcomes based on Brigham and Women’s Home Hospital randomized control trial show a 52% decrease in direct costs; decreased utilization of lab orders, imaging, and consultation in patients discharged to visiting nurse home health; increased physical activity levels during hospitalizations; and decreased readmissions 30-days post-discharge all while maintaining the same quality and safety that patients receive in the inpatient setting. Most importantly, this program is giving patients an option that increases access to quality care and decreases the burdens associated with an inpatient stay.
The Partners Mobile Observation Unit (PMOU) aims to improve patient care, increase access, and lower health care costs by providing home-based urgent care for patients with limited mobility, who are experiencing acute medical events believed to be treatable with enhanced home care. The Partners Mobile Observation Unit is a high-quality alternative to emergency services and hospitalization. It is available for Partners patients who would benefit from additional medical treatment and support in the safety and comfort of their own home.
The PMOU program, co-led by Partners Home Health and the Center for Population Health, has been in existence since June of 2013. During the 4-year period from August 2014 to July 2018, the program has serviced 3,200 patients.
The typical patient referred to PMOU is chronically ill, frail, elderly (average age is 80+ years), and often challenging to keep out of the hospital. Patients are referred to PMOU from their Partners primary care provider, a Partners Specialist, or sometimes the emergency department, and typically fall into two or more of these categories:
- Significant change in clinical condition that requires a medical assessment
- High-risk/urgency of condition or health status
- High in-patient or ED utilization rates
- Engaged with the High-Risk Care Management Program
- Patients who are unable to be seen in their primary care office within 24 hours or other health care facility like a walk-in clinic or urgent care center
- Have difficulty with transportation or are homebound
During a Partners Mobile Observation Unit visit, a Partners Home Health nurse practitioner is deployed to a patient’s home to conduct a clinical evaluation with diagnostic assessment and initiation of a treatment plan. The home is evaluated for safety and barriers to the patient’s ability to recover at home. PMOU provides a high level of care coordination with the patient’s primary care providers, other clinicians, and family members.
To learn about this program, visit our Assistive Technologies page.