There's No Place Like Home: Exploring Home-Based, Acute-Level Healthcare.

Innovative healthcare delivery models that substitute for hospital admission are key to effective healthcare reforms. Ideal alternative strategies will promote patient-centered care and alleviate the burdens of an aging population and limited healthcare funding. An emerging strategy is home-based care, with roots in physician house calls of the past, enabling acute-level care to be provided to patients within their own places of residence. This type of home healthcare better integrates with the needs and preferences of chronically ill, frail, or cognitively deficient patients, for whom a hospital admission could be stressful, disruptive, and potentially harmful. A prominent, practical example of home-based, acute-level healthcare is the Hospital at Home® (HaH)8 program. HaH was developed at Johns Hopkins University Schools of Medicine and Public Health approximately 20 years ago and has since spread to other major US and international medical centers. Dr. Bruce Leff, a leader of the HaH initiative, defined this type of care as “the community-based provision of services usually associated with acute inpatient care.” Patients presenting to the emergency room (ER) or other clinics of a hospital with an affiliated HaH program are assessed for eligibility. Those with conditions such as community-acquired pneumonia, acutely exacerbated heart failure or chronic obstructive pulmonary disease, pulmonary embolism, or cellulitis are considered, but may be excluded if, for example, they also present with uncorrectable hypoxemia or ischemic chest pain. Instead of being admitted to the hospital, eligible patients are sent home with an HaH team, consisting minimally of a physician and nurse who can develop and implement a coordinated care plan to resolve the acute episode. In addition to the HaH model, there are other ongoing initiatives to provide home-based, acute-level care to patients. For example, a collaboration within Alberta Health Services in Canada has been developed to enable emergency medical …