SCAN reposted this
President and CEO, SCAN Group & Health Plan
Among the most heralded emerging care models is the “hospital-at-home” model, which aims to move management of low-acuity hospital patients to home-based settings. On its face, hospital-at-home aims to solves multiple problems at once: 1) addressing diminishing hospital inpatient bed capacity in the face of an aging population; 2) patient and caregiver frustration with the lack of convenience of inpatient settings; and 3) more robust postepisode management of acutely ill patients. Having led one of the largest early hospital-at-home programs, I have been an early and persistent supporter of the transition of care from hospital to home. That said, my optimism has been tempered somewhat with observations from the real-world implementation of hospital-at-home models in traditional fee-for-service health care environments. I share these observations in a new column in JACC Journals called “Au Contraire.” Thanks to Tariq Ahmad MD MPH for the opportunity to share my perspective.
Hospital-at-home models show great promise in improving capacity, convenience, and care management, but implementation challenges remain in FFS environments.
Happy to see this reality test of hospital at home by someone with significant expertise. Along with pullbacks of pharmacy-based clinics, this calls for those of us in community-based care to work even harder to develop workable models and technology to achieve the full potential of home-based care.
Well said, promising but not a perfect solution.
Nice piece and love that it moves beyond the home-based care infatuation to realistic experience based insights. Your main point resonated with me—we need to prioritize/focus resources on preventing the need for hospitalization in the first place.
Extremely insightful Dr Jain. I love how you have applied ‘toxic positivity’ to this scenario. No one ever speaks about the impact ‘hospital at home’ has on the caregiver, and sometimes leading to caregiver getting sick or in extreme cases even dying burdened with the emotional and physical toil.
Does in-patient bed capacity shortages refer more often to physical bed space or staff to man the beds?
James Case
3w
These types of innovations are going to continue to be difficult to implement within the constraints of the payment system design. It needs to be reconsidered from first principles.
OncoDaily
2w
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Look forward to reading this. So interested in learning more and understanding the nuances and intricacies we often don’t see when people advocate For this
Medical Director, Pain Management, Cancer pain management, #Outcomes research, #Neuromodulation
2wLove this article. I have wondered when (which generation of people) was it determined that home based care is better. It is a good concept that we need to carefully review resources and possibilities for every case. Problems arise when we try to have a single approach for every person. For our generation, all around me I see people have moved away from their extended families. Both husband and wife are working. Parents caring for children are older (compared to previous generations). Grand parents are older. When someone needs care everyone seems to be stuck with work calendars that were set 6 months ago. I am seeing this in India as well especially in metropolitan cities. There is no one home to have any bandwidth for care. I have come across patients whose family members are working hard to make ends meet. Ofcourse they also sign up to be the PCA. They have shared directly that they rather double up on commitments to make ends meet 🤷♀️. Meaning they are not there for the duration of PCA duties. Medical models probably need to keep up with quickly changing communities.