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2 results

  • 12 - A Pathway for High-Value Home Hospital Care in the United States

  • from Part IV - Reimbursement Considerations for Digital Home Health
  • Edited by I. Glenn Cohen, Harvard Law School, Massachusetts, Daniel B. Kramer, Harvard Medical School, Massachusetts, Julia Adler-Milstein, University of California, San Francisco, Carmel Shachar, Harvard Law School, Massachusetts
  • Book:
    Digital Health Care outside of Traditional Clinical Settings
    Published online:
    25 April 2024
    Print publication:
    02 May 2024, pp 173-184
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  • Summary

    During the COVID-19 pandemic, precautionary measures were implemented to reduce the spread of SARS-CoV-2, including the introduction of the Acute Hospital Care at Home waiver by the Centers for Medicare & Medicaid Services (CMS). The integration of home hospital services in the US health care delivery system has created new opportunities to address social determinants of health (SDOH) and improve the value of care, such as delivering preventative services at the optimal time, coordinating care across sites, and prioritizing patient needs and preferences. While at-home care programs are not new, emerging technologies have the potential to remove barriers to their adoption – if policymakers get the conditions right. Furthermore, while public and private payers are developing new payment models to address SDOH, little is known regarding the feasibility of their application to home hospital programs across the US. Informed by Mayo Clinic patient and staff interviews in Arizona, Florida, Minnesota, and Wisconsin, this chapter proposes evidence-based policy recommendations to facilitate high-value home hospital care, of which the equitable use of digital tools is a critical component. Regarding statutory reform, it advances a model policy that is flexible enough to incorporate high-value home hospital care not yet conceptualized. Considering reimbursement strategy, this chapter proposes guidelines for payment reform initiatives addressing SDOH to include provisions for access to digital tools that facilitate home hospital care. Lastly, this chapter outlines principles for nurturing a cybersecurity-conscious culture in home hospital programs as digital health care evolves.

  • Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility

  • Esther-Lee Marcus, Jeremy M. Jacobs, Jochanan Stessman
  • Journal:
    Palliative & Supportive Care / Volume 21 / Issue 3 / June 2023
    Published online by Cambridge University Press:
    10 March 2022, pp. 429-437
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  • Objective

    The number of patients treated with prolonged mechanical ventilation (PMV) is steadily rising. Traditionally treated within specialized long-term care facilities (LTCFs), healthcare providers are increasingly promoting homecare as a technologically safe, humane, and cheaper alternative. Little is known concerning their informal caregivers (ICGs), despite their crucial role in facilitating care. This study examines caregiver strain among the primary ICG of PMV patients treated at home vs. LTCF.

    Method

    This study was an observational cross-sectional study. The study enrolled 120/123 PMV patients ≥18 years within the study region (46 treated with homecare/74 treated at the LTCF) and 106 ICGs (34 ICGs/46 homecare patients and 72 ICGs/74 LTCF patients). Caregiver assessment included the 13-item Modified Caregiver Strain Index (Mod CSI) (0–26 maximum); patient assessment included symptom burden (the revised Edmonton Symptom Assessment System).

    Results

    The mean age of ICGs was 58.9 years old; 60.4% were females; 82.1% were married; 29.2% were patient's spouses; and 40.6% were patient's children. The total Mod CSI was 13.58 (SD 6.52) and similar between home vs. LTCF (14.30 SD 7.50 vs. 13.26 SD 6.03, p = 0.50), or communicative vs. non-communicative patients (13.50 SD 7.12 vs. 13.64 SD 6.04, p = 0.93). Hierarchical analysis identified three clusters of caregiver strain, with ICGs at home vs. LTCF reporting significantly lower mood strain, higher burden, and similar levels of lifestyle disturbance. In adjusted models, homecare was significantly associated with reduced mood strain and increased burden, while increased patient symptomatology was significantly associated with total strain, mood, and burden strain clusters.

    Significance of results

    Recognizing the different patterns of caregiver strain at home or LTCF is a prerequisite for addressing their palliative care needs and improving the wellbeing and resilience of informal caregivers, who often play a critical role in deciding whether to treat the PMV patient at home or LTCF.