Bringing Hospital Care into the Home: Designing for Spread of AMCAH and SY@H

Abstracts from the Kaiser Permanente2018 National Quality Conference


Bruce Cohn, MD; David Wong, MD; Zeth Ajemian, MA

From Northern California, Southern California, Program Offices

Background: The combination of an aging population requiring greater health care and increasing cost pressure on patients, families, and the health care system mandates that high-value solutions to common health care services be developed. Safety, efficiency, efficacy, and patient satisfaction help define high-value solutions to health care problems. Integrated health care systems need to exploit their unique assets to aggressively explore new models of high quality care. These programs are part of an ongoing trend to appropriately relocate care outside of the hospital setting.
Methods: The Advanced Medical Care at Home (AMCAH) program at Riverside Medical Center enrolls adult Kaiser Permanente (KP) members meeting InterQual criteria for hospital admission who present to the Emergency Department, Urgent Care Center, or Outpatient Clinic, or who meet early discharge requirements from the hospital with a qualifying diagnosis. This program targets patients who require acute hospitalization for the following diagnoses: Congestive heart failure, cellulitis, diverticulitis, chronic obstructive pulmonary disease, pneumonia, and pyelonephritis. Key elements of the program include physician and nursing care, medication management, laboratory tests, member education, caregiver education, home safety assessment, and phone access to clinical support. The See You @ Home (SY@H) Program at Roseville Medical Center enrolls patients who either: 1) present to the Emergency Department; 2) are identified in the hospital; or 3) are identified as having increased risk for acute hospitalization and can receive appropriate interventions at home, in lieu of hospital admission or continued hospitalization. Patients receive daily physician interventions from hospital-based physicians that include home visits, administration of parenteral medications, and appropriate laboratory monitoring. Physicians are available to patients and families by direct telephone access 24/7. Home health nurses are used to provide care when appropriate. Following resolution and stabilization of the acute medical illness, care is transferred to typical outpatient practitioners. A case control matching analysis was used to evaluate program outcomes.
Results: AMCAH and SY@H have demonstrated excellent clinical outcomes, safe and effective medical care at home, prevention of decondition and reduced mobility, low programwide readmission rates, and the prevention of hospital-acquired conditions. Satisfaction results are positive in all aspects of care with patients once in the program requesting admission to AMCAH or SY@H vs hospitalization. AMCAH, on the basis of regional financial analysis, has shown the program is cost favorable compared with traditional hospital care for 7 and 30 days postepisode of care. SY@H has demonstrated utilization outcomes supporting expansion of this alternative care model. Enrolled patients were compared to nonenrolled patients based on diagnosis, gender, age, comorbidity (Comorbidity Point Score, v 2), and measures of acute physiologic derangement (Laboratory Acute Physiology Score, v2).
Discussion: AMCAH and SY@H deliver the right care, at the right place, at the right time. These innovative models transform the way KP cares for patients and adds value by focusing on patient-centered care. Eligible members are receiving time-limited acute care services in the comfort of their own homes as an alternative to hospital admission and inpatient care. KP Southern California seeks to spread and scale the AMCAH program from Riverside Medical Center, starting with Panorama City Medical Center and working with additional demonstration sites to establish operating practices that support regional and national spread. KP Northern California has expanded SY@H to the Sacramento Medical Center as a first step toward spread.

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