Island Health is the publicly funded healthcare provider in the southwestern portion of the Canadian province of British Columbia. Island Health's hospital-at-home program was created to determine whether treating acute-care patients in their own homes is as effective as in-hospital treatment.

The program was launched to enable patients to receive safe, effective care virtually and in-person from providers experienced in hospital medicine and acute care. Hospital-at-home programs have been successfully implemented across the globe but have yet to achieve critical mass in North America.

The benefits of hospital-at-home programs can include a more patient-centered approach to hospital care, lower rates of hospital-based complications, such as infection, and reduced pressures on hospital beds and emergency departments.

In formally gathering feedback from Island Health's hospital-at-home patients, 98% of patients interviewed have said that if they had the opportunity to enroll in the hospital-at-home program again, they would.

Sean P. Spina, PharmD, is director of special projects at the Vancouver Island Health Authority in Victoria, British Columbia. Healthcare IT News sat down with Spina to glean his insights on the hospital-at-home program in a preview of his upcoming HIMSS22 educational session, "A Hospital at Home Program Raised Patient Satisfaction." (Click here for a special video from Spina on the hospital-at-home program.)

Q. What are a couple of the potential benefits that a hospital-at-home program can provide for patients and providers?

A. Island Health's hospital-at-home program is an innovative patient-centered care model that offers patients and families an acute-care alternative by providing 24/7 hospital‐level care in the patients' homes. Hospital-at-home aims to improve patients' acute-care experience by changing the way acute-healthcare delivery is provided and used.

By leveraging best practices in public and patient engagement, the hospital-at-home team created a new acute-care model that meets the needs of both patient/family caregivers and healthcare providers.

Over the past decades, hospitals have trialed various initiatives to deal with hospital overcapacity – a problem often associated with poor care experiences. These interventions are seldom durable and rarely patient-centered.

During an admission, patients may experience fear, separation and loneliness – experiences exacerbated by COVID-19. Hospital at home allows patients to remain at home close to loved ones, transforming an acute-care stay into a more compassionate experience. Recognizing the vital contributions of patients and families, the hospital-at-home team invited them to partner with them to co-create, learn, adapt and scale a more meaningful acute-care solution.

A collaborative patient-oriented research and Island Health evaluation team has developed an evaluation framework grounded in patient and family caregiver priorities to assess the impact of the program. The research is still under way, but 15 months after its launch, hospital at home has provided care to just over 600 patients.

Early observations showed that most patients prefer being home rather than the hospital and are more active and comfortable at home, which is more conducive to healing. Patients in hospital tend to stay in bed. In contrast, at home, people get up in the morning, they get dressed, and go on with their day. They're much more mobile.

That mobility can lead to better mental and physical health, and results in a person who is still productive, even though they are technically in a "hospital bed." The majority of hospital-at-home staff (93%) rate hospital at home as an excellent/very good place to work. All patients and family caregivers (100%) who have completed the post-discharge evaluation survey (n=344) stated they would recommend hospital at home to family and friends.

Hospital at home improves patients' acute-care experience by changing the way care is provided and used, and in doing so, fosters patient autonomy and self-management. The care collaboration and level of information-sharing intrinsic to hospital at home solidifies patients, families and healthcare providers as true partners in care.

Q. Which roles should be included in a hospital-at-home care team, and why?

A. Island Health's hospital-at-home program is an extension of the brick-and-mortar hospital providing acute-care services to those patients admitted to the program. As a result, it was important during the planning and implementation of the program that the hospital-at-home healthcare team consist of the same elements as to what is offered at the brick-and-mortar hospital.

The hospital-at-home team includes allied health clinicians, pharmacists, physicians, nursing unit assistants and registered nurses. These healthcare providers are highly experienced in hospital medicine and acute care. Collectively, these providers see each patient multiple times a day.

What differentiates Island Health's hospital-at-home program from others is that if patients deteriorate, they are admitted directly back into the hospital, whereas other programs send these patients to emergency departments.

As the number of patients cared for in the program increases, the team has realized that there are nuances that differentiate this type of care versus traditional models. As a result, based on the experiences and feedback from stakeholders, the team is exploring a variety of alternate options to ensure that the appropriate mix of professionals are involved to provide equitable access to the service.

Q. As an overview, what is the technology investment required to implement a hospital-at-home program?

A. Hospital-at-home practice models of care around the world have been implemented previously with minimal technology. When Island Health implemented the hospital-at-home model in 2020, it initiated a plan to augment in-person care with various types of technology.

It hypothesized that by incorporating technology supports into its model, the care teams would be better equipped to efficiently deliver safe, effective, acute care to patients in their own homes.

The comprehensive stakeholder engagement initiative that was completed during program development highlighted that effective communication is critical to patient care and safety. Island Health's hospital-at-home program uses a video and text-messaging platform that facilitates secure and seamless communication and collaboration among care team members.

Clinicians and at-home caregivers use the communications platform to share messages about care plans and treatment options or changes to patients' health status. Contributing to the program's success was the availability of virtual "call bells," which were put in place based on feedback from patients.

While not originally considered by administrators, patients suggested making such a component available to give them more confidence in the hospital-at-home program, make them feel safe while being cared for at home, and allow them to connect immediately with a clinician.

Since program launch, new remote-patient-monitoring innovations have come to market, and there is a willingness of healthcare organizations to investigate how these new technologies can improve patient care.

It is exciting to see how both healthcare organizations and technology companies are focused on empowering patients and family caregivers to be more involved with their own care, while at the same time, extending the reach of the clinical staff to facilitate the delivery of patient care in new and innovative ways.

Spina's HIMSS22 session, "A Hospital at Home Program Raised Patient Satisfaction," is scheduled for Wednesday, March 16, from 4-5 p.m. at the Orange County Convention Center in room WF4.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.