By Greg Freeman

The Hospital at Home care model is gaining favor with hospitals and health systems as a way to provide hospital-level care in a patient’s home while lowering costs by almost one-third and reducing complications. The approach is receiving more attention now as a way to avoid asking patients to come to the hospital during the COVID-19 pandemic.

The program was developed at the Johns Hopkins Schools of Medicine and Public Health and tested at multiple hospitals. (More information on the model is available online at: hospitalathome.org.)

The results are promising, but where do quality improvement activities fit into this new model? The good news is the traditional tenets and goals of quality improvement remain the same with Hospital at Home, says Summer Knight, managing director in the life sciences and healthcare practice at Deloitte in Philadelphia. “Although in many ways novel, Hospital at Home is not so different from a virtual hospital wing, but the infrastructure is digital rather than physical steel and concrete,” she says. “If quality management is done well, then QI and patient safety fits into Hospital at Home in the same way it fits into other aspects of care.”

The starting point involves similar metrics that affect standards of care, such as blood clots from lack of movement and anticoagulation (e.g., DVT, hospital-acquired infections, length of stay, and mortality). Since care from Hospital at Home is connected to the hospital digitally, quality professionals can collect data throughout the care process, even to specific date/time stamps to examine timeliness of care, such as medication administration and response to events.

“Expected outcomes from a patient perspective will still be measured to assess if a problem has resolved clinically or returned to the level of functional status that was expected,” Knight says. “Did you receive the attention you needed and expected when you most wanted it? Was the cost of care from your perspective, out of pocket expense and copays, what you expected? Instruments for comparing satisfaction should evolve as patients pivot from the familiar inpatient environment to the new Hospital at Home programs.”

These program administrators will continue to assess clinical quality, both outcomes and process, along with service and cost. As more tech-care partnerships form to enable similar programs, and as acute care moves from inpatient settings into patients’ homes, service-level agreements increasingly will carry provisions that affect QI and patient safety metrics.

“While QI professionals focus on data, the sources of the data, the speed and frequency at which it is delivered, will move to continuous feeds and then to proactive advanced analytics that can forewarn of future events. In some respects, this represents both an expansion into a new arena as well as a shift of professional capability,” Knight says. “The use of these raw data to improve the delivery of care is an opportunity that has not been fully captured to date in ‘standard’ care.”