Achieving scale in Hospital at Home care through smart technologies

Interest and implementation of Hospital at Home (HaH) programs (defined as delivery of hospital-level care in patient homes) has expanded considerably over the past few years, particularly at the peak of the pandemic when many hospitals grappled with an unprecedented shortage of inpatient beds.

As a fairly new care model to Asia, much work still remains in optimising such services in terms of efficiency, effectiveness and patient experience.

The evolution of HaH, particularly across Singapore and Asia, were top of mind at HMA’s recent Hospital at Home Asia 2022 conference. Organised in partnership with Singapore’s MOH Office for Healthcare Transformation (MOHT), this event brought together healthcare leaders from Singapore, Australia and the US. Over the course of the conference, delegates shared success factors from their respective HaH programmes as well as the care coordination technologies that can be adopted to optimise these models for scale.

The role of clinical command centres 

In his keynote speech, Mr Joe Cain, Business Development and Partnership Leader, Enterprise Care Collaboration, Philips APAC, highlighted the role of the clinical command centre in this redesign of care delivery.

Particularly for HaH programs, clinical command centres present a holistic view of data from both inpatient and at-home perspectives, including remote monitoring of patient vital signs.

Such integration of data can help drive growth and confidence in HaH services from referring clinicians, he noted.

He raised the example of Grampians Health, a regional health system in Victoria, Australia. Grampians had seen a strong demand of admissions to its HaH programme over the past 5 years, with an average of 20 to 30 patients in the programme at any given time.

However, an analysis of length of stay data showed that there was a significant number “long-stay” patients, who consumed a high volume of bed days both in hospital and at home – with some patients requiring over 50+ days of HaH care.

This was where comparison of data sets uncovered a finding: that long-stay HaH admissions correlated with increasing complexity of DRG (diagnosis-related groups).

“Through this analysis we propose referring complex, yet stable, patients to the HaH program earlier to help to help boost hospital capacity while maintaining acute level  care,” said Mr Cain.

Furthermore, benchmarking Grampians’ HaH service utilisation against that of other Australian hospitals revealed that for most DRGs, the proportion of HaH stays (as part of total hospital stays) at Grampians is below the national average.

Across Australia, HaH is performed on an average of 6% of multi-day separations, while the figure stands at less than 4% at Grampians.

This further suggests that it is reasonable to increase HaH admissions across most DRG profiles at Grampians, which will reap a substantial savings in bed days.

This growth can be achieved by leveraging on clinical command capabilities, Mr Cain pointed out.

“With clinical command centres, hospitals will have increased visibility of patients who are eligible for HaH at any given time, and therefore drive more referrals to the program. Clinicians can expect better integration of home monitoring devices in a way that closely replicates hospital-based monitoring and therefore more patient data to leverage in between consults. These data points will also help to prioritise virtual and face-to-face consults for clinical operations.”