May 07, 2021 – An at-home discharge service piloted at Penn Medicine successfully prevented hospital readmission in nine out of 10 emergency department patients, according to a study published in Healthcare that suggests alternative payment models could benefit patients and healthcare stakeholders alike.
The Practical Alternative to Hospitalization (PATH) program aimed to prevent rehospitalization by providing home-based patient support after emergency care.
Penn Medicine researchers conducted a 14-day trial for the service in December 2019. According to the study, the program cut emergency department wait times by an average of 8 hours for enrollees. PATH enrollees also had hospital stays that were two days shorter, on average.
“The culture is shifting where we realize that hospitalization is not always the best option for patients – particularly patients with chronic illness,” Austin Kilaru, MD, an emergency physician at Penn Medicine and one of the study’s lead authors, said in a press release. “We need to find better ways of helping patients not just get healthy in a hospital, but stay healthy at home – whenever they are ready to be there.”
An advanced practice provider (APP) screened hospital bed requests to select program participants based on factors like the reasons for the patient’s visit, her vital signs, medical history, and social support systems. After approval from the emergency physician, enrollees received a comprehensive care plan in partnership with that physician and the patient’s care team.
Many of the patients enrolled in the home-based discharge program had common conditions like chest pain, high blood sugar, and congestive heart failure.
Once the patient was home, the hospital conducted patient outreach through phone calls or text messages to evaluate the patient’s status, coordinate outpatient appointments, and schedule additional diagnostic testing. The program also provided certain patients with transportation assistance, home nursing visits, and physical or occupational therapy.
“We were concerned that emergency physicians would be reluctant to discharge patients who they would have normally hospitalized, but it turns out that they liked having the option of choosing our services,” Kilaru said. “It’s a new alternative to staying in the hospital or going home completely on their own. We were seen as an added support, acting in the best interests of patients and medical providers alike.”
Just four out of 30 patients had a hospital readmission within 30 days of their first visit.
“Another concern in this pilot was that patients might have worsening illness at home and need to return to the emergency department,” Kilaru said. “Fortunately, our patients did well and had good outcomes – even 30 days later. We created careful safeguards to select the right patients, so while a few patients did need to return, it was not unexpected, and we could help communicate key medical and social issues to the emergency department and hospital teams.”
While Penn Medicine paused the home-discharge service due to COVID-19, the pandemic has sparked interest in home healthcare. Lessons from this study have been applied to COVID-19 efforts at Penn Medicine, where it created an “accelerated care pathway.” This care plan applies to ED COVID-19 patients who only need short hospital stays. Then, clinicians monitor patients closely at home.
David Resnick, a senior innovation manager at Penn Medicine’s Center for Health Care Innovation and co-author of the study, noted that the study’s findings suggest that alternative payment models for hospital care could benefit payers, health systems, and patients alike.
“Payers benefit by having their members avoid costly inpatient stays,” said Resnick. “Patients benefit by having more safe days at home. And hospitals with busy emergency departments and full beds benefit by freeing up resources that can be utilized by the most sick and complex patients.”