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Hospital at Home

  • Hospital at Home (H@H) is a service where eligible patients may receive hospital-level, acute care in their home.
  • A physician, nurse, and other interprofessional team members provide care through a combination of in-person visits at the patient’s home and virtual visits using phone and/or video. Technology will also used to monitor a patient’s condition.
  • The program is voluntary for eligible patients/caregivers who live in close proximity to the hospital, and who have good support and coping capacity at home. Patients and caregivers, along with the care team, can determine if participation in the program is appropriate.
  • Care is short-term (3-7 days) and is provided 24 hours a day, 7 days a week, and 365 days a year.
  • The program allows for immediate transfer into hospital (bypassing the Emergency Department) if the patient’s condition deteriorates at home.
  • The program allows patients to choose a safe and effective alternative to traditional in-patient treatment.

The Hospital at Home program intends to:

  1. Improve patient and caregiver satisfaction
  2. Reduce/improve transitions in care
  3. Reduce risk to patients (hospital-related risks such as infection, decline of function, cognition/delirium, changes in mental health)
  4. Improve utilization of acute beds
  5. Facilitate appropriate and efficient discharge
  6. Strengthen the Northern continuum of care
  7. Enable longitudinal, system-wide cost savings

Northern Health, the Prince George and Northern Interior Rural Divisions of Family Practice, Medical Staff Associations, BC Emergency Health Services, and the First Nations Health Authority are collaborating to develop the Hospital at Home prototype for Prince George, which will launch in March 2021.

The Hospital at Home Prince George prototype, based out of UHNBC, will use a quality improvement approach for implementation, beginning with a small number of low-acuity patients as we test out processes. We’re working with physician representatives from the Prince George Division of Family Practice and the UHNBC Facility Engagement Working Group to design this service to benefit patients, families, and providers, as well as being applicable to other northern communities.

The prototype focuses on providing home-based acute care services for the following:

  • For the prototype phase of Hospital at Home, we remain focused on the following patient specific complex medical populations:
    • Patients already receiving community-based palliative care services who temporarily require acute-level care (i.e., for a pain crisis, uncontrolled symptoms, congestive heart failure).
    • Patients who require enhanced IV therapy that extends beyond regular services to allow time for adjustments to medication routine that will fit within regular extended hours services.
  • Given the complexities of getting started with less predictable complex medical patients, a test population has been established to trial the first few admissions:
    • Specific post-surgical patients who require 24-hour care following surgery (i.e., laparoscopic assisted vagina hysterectomy).

Over time, the program will expand the patient population to include stable acute medical patients, stable acute surgical patients, and patients experiencing acute mental health episodes.

FAQ's

Where in Northern Health will it be available?
  • Hospital at Home will first launch through the University Hospital of Northern BC (UHNBC) in Prince George with additional sites being determined in 2021.
  • Throughout January and February 2021, the Prince George implementation team will be testing processes and admitting a small number of lower acuity patients, which will allow improvements to be made as more patients are admitted into the program.
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Who is the target population?
  • For the prototype phase of Hospital at Home, we remain focused on the following patient specific complex medical populations:
    • Patients already receiving community-based palliative care services who temporarily require acute-level care (i.e. for a pain crisis, uncontrolled symptoms, congestive heart failure).
    • Patients who require enhanced IV therapy that extends beyond regular services to allow time for adjustments to medication routine that will fit within regular extended hours services.
  • Given the complexities of getting started with less predictable complex medical patients, a test population has been established to trial the first few admissions:
    • Specific Post-Surgical Patients who require 24 hour care following surgery (i.e.: Laparoscopic Assisted Vagina Hysterectomy).

Over time, the program will expand the patient population to include stable acute medical patients, stable acute surgical patients, and patients experiencing acute mental health episodes.

  • Patient eligibility is assessed against defined demographic and clinical characteristics. This includes basic criteria such as:
    • Do they have a known diagnosis, and are they clinically stable?
    • Are they unlikely to require multiple in-hospital tests, treatments or consultations?
    • Do they have a safe home environment and a caregiver in the home?
    • Do they live close to the hospital?
  • Patients and caregivers must provide informed consent for admission to the program. Admitting physicians are expected to consider any other relevant factor(s) that may affect the patient’s likelihood of doing well in the Hospital at Home program.
  • When determining whether someone is eligible for the program, their health and safety is always of the utmost importance.
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What services will be provided?
  • Working groups have helped to design the program and with H@H staff now recruited, they will begin testing the feasibility of several functions that will be offered. The intention is to add functions one or two at a time as we expand the patient population. Currently, we are looking at the following:
    • Progress monitoring
    • Palliative care services for patients requiring more medical attention (e.g., adjustments in pain medications, aggressive treatment of poorly controlled symptoms/worsening of symptoms)
    • IV treatments, including antibiotics, fluids, and certain IV medications
    • Medication initiation and titration
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What are the benefits?

Programs similar to Hospital at Home have been used in other jurisdictions worldwide, where they have been shown to improve patients’ and families’ experiences of care.

  • Many research studies have shown that this type of program provides the same or better care than traditional inpatient hospitalization, including three Cochrane medical reviews, which represent the highest standard in evidence-based health care research.
  • A hospital stay can sometimes pose physical, cultural, financial or psychological barriers to accessing care that, for some, can be reduced by being at home.
  • Receiving care at home can help minimize disruption to relationships with family, caregivers, and community, as well as disruption to other important parts of day-to-day life such as diet, sleep, and hobbies.
  • Hospital at Home can reduce risks to patients associated with time spent in hospital, such as infection and decline in function, cognition/delirium, and changes to mental health.
  • By providing short-term acute care in the patient’s home, the program will improve access and increase efficiency. It will do this by reducing pressure on in-patient hospital beds, decreasing hospital congestion by optimizing patient flow, and improving overall system capacity.
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What happens if a patient starts deteriorating?
  • If at any time a patient’s condition deteriorates at home, the program allows for their immediate transfer into hospital (bypassing the Emergency Department).
  • Hospital at Home will have systems and processes in place to quickly recognize, respond to, and escalate care for deteriorating patients.
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How will physicians be compensated for participating in this program?
  • A physician compensation model for the Hospital at Home program has been developed and proposed to the Ministry of Health. There are weekly discussions with the Ministry of Health around an interim compensation model and long-term fee code changes.
  • The physician compensation framework will be provincially consistent and based on guiding principles. The Ministry will adjust the approach as needed, based on learnings as the program rolls out across the province.
  • This framework will include two approaches to align with existing inpatient staffing models within sites.
    • The first approach aligns with sites currently providing inpatient services via MRPs on a service contract (e.g., hospitalist model being used in Island Health).
    • The second approach aligns with sites providing inpatient services using MRPs billing fee-for-service (e.g., family practice physicians in Northern Health).
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How does the program work in other jurisdictions?
  • There are many examples of programs similar to Hospital at Home around the world:
    • In Australia, the first Hospital in the Home program was introduced at the state level in 1994.
    • John Hopkins Hospital in the United States introduced their Hospital at Home program in 1995.
    • The Australian state of Victoria is currently running their program with about 500 ‘virtual’ hospital beds in 52 services sites across the states.
    • The program has been very well received by both health-care professionals and the public and is heavily used in both the United States, particularly in veteran’s hospitals, and Australia.
    • Scotland is also working to expand its existing programs, and the National Health Service in England also offers some Hospital at Home programs.
    • A pilot Hospital at Home program was offered in Toronto; we have incorporated lessons from that experience to the BC prototype. 
    • Alberta also has a program called Hospital at Home; however, that program is quite different from the BC approach.  
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