Home Health Virtual Complexivist Physician Program: Leveraging Increased Scope of Care at a Crucial Time



 

Alicia Ahn, MD; Sandra Barton, MD; Binitha X Surendran, MBA, MS

https://doi.org/10.7812/TPP/19-039-43

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northwest

Background: The Home Health Virtual Complexivist Physician program was launched in 2014 as a grassroots effort by an innovative physician who saw a need to provide physician-level care to supplement the home-health visit. After 4 years of piloting workflows, the program now offers 3 virtual physicians who act as the temporary primary care physician for patients while they are receiving home-health services. These physicians take calls from field clinicians (nurses, therapists, and social workers) at the time of the home visit.
Methods: Kaiser Permanente members receiving home-health services from a Kaiser Permanente agency (n = 500) and multiple contracted agencies (n = 500) establish “Doctor of the Day” consultation line staffed by physicians to take calls from home-health nurses, therapists, and social workers when in the home. The program is primarily conducted using telephone calls but also uses a telemedicine resource (“telmedx”) that enables 1-way radio and 2-way voice and is operated via cellular service, and thus is not dependent on home Internet or WiFi access. The physician can capture still photos from video and upload them to the patient chart. Metrics included hospital admission rates at 14 and 30 days, patient experience, home-health field clinician experience, and costs.
Results: Qualitative results include improved clinician experience. These field clinicians appreciate having a physician call at the time of the visit. The results identify improved timeliness, effectiveness, efficiency, and patient care experience as benefits of the program. The office-based primary care practitioners are appreciative of the care and coordination provided by the virtual physician team. The post-acute (skilled nursing facility) providers appreciate the opportunity to provide “warm hand off” to the home-health team for particularly complicated patients. Quantitative results show a sustained reduction in 14- and 30-day hospital admission and readmission rates from before the program was fully staffed (2013-2015) to full staffing (2016-2018). These data are limited to the Kaiser Permanente home-health agency patients; we have not collected data from our contracted agencies at this time.
Discussion: The virtual physician service provides a unique opportunity to identify problems before they escalate. For patients who require transfer to acute care, the physician notifies the Emergency Department with warm handoff. Field clinicians appreciate physician consultation and teaching and can deliver more effective, patient-centered home-health care. Patients appreciate the opportunity to collaborate on a plan that meets their needs and wants. This often means a trial of “care at home” in which the physician will order services such as mobile imaging, phlebotomy, oxygen, and medications, and will arrange visits on a more frequent basis. Future innovations might include investigating a dedicated clinical nurse navigator to provide proactive outreach.

Abstracts from the Kaiser Permanente 2019 National Quality Conference

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