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How a new hospital-at-home program helps patients and Parkland Hospital

Hospital at Home photo.jpg
Parkland Health and Hospital System
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Parkland Hospital staff assist Gary Jackson, the first patient in its Hospital at Home program

The pandemic and shortages of physicians and nurses have put a strain on hospital staff and capacity. Parkland Hospital’s starting to address some of those problems by delivering acute care directly to the patient. KERA’s Sam Baker talks with Alissa Tran, director of Parkland’s Hospital at Home program.

Services of the Hospital at Home program

In-person nurses come to the house a minimum of twice daily. A physician or an APP sees the person in person, or they can do a telehealth visit via video conference.

We provide all the medications, lab tests, physical therapy, any imaging that's needed, of course, all transportation to get to and from those imaging appointments.

What Parkland also does is provide remote patient monitoring equipment to monitor vitals 24/7.

Who's eligible? 

They have to meet inpatient criteria, meaning they would have otherwise been in the brick-and-mortar hospital. This is different from home health, which is post-acute care, or what happens after a patient is discharged from the hospital.

They must pass a clinical screening. We want to make sure that we can provide care in the home safely. For example, we wouldn't take someone from an ICU or from a step-down unit. They need to meet at the same level of care that is safe for the patients to be at home.

They also have to pass a social screen, to ensure their home is safe.

We take all patients who are unfunded and underfunded. Most government insurances pay for this program, and there are some commercial insurances that cover hospital-at-home programs. And of course, this is no additional cost to the patient. This is just like they would be in a brick-and-mortar hospital.

Give me an idea of the type of patients who are in the program.

So, we take a lot of patients who have infections that can't be treated necessarily with home health or they don't have a place to go. We do a lot of infectious diseases, a lot of heart failure, patients that are needing I-V diuresis

Why would such people then opt for hospital-at-home as opposed to being in the hospital? 

And so a lot of times it's a patient's choice. They’d just rather be at home. They'd rather be eating their own food or, you know, with people that they're familiar with.

Sometimes they have things that they need to address. Our first patient was a dressmaker and he worked from home and he needed to get dresses made and that sort of thing. And he couldn't do that in the hospital. But we were still able to provide that high level of care to take care of the patient while he was still being treated, and he could do what he needed to do at home.

Why did Parkland begin such a program?

That's kind of threefold:

  • Patients are more active at home. They are more engaged in their care and they tend to be more satisfied with their care.
  • We also see fewer falls at home, fewer hospital-acquired conditions like bloodstream infections or, you know, catheter UTI kind of infections or pressure ulcers.
  • For Parkland, we are essentially increasing our bed number by being able to take care of these patients at home and living in the brick-and-mortar hospital for those with potentially a bit higher acuity that need 24 seven nursing care.

When you consider the rising shortage of physicians, rising shortage of nurses, and the toll the pandemic has taken on Parkland as well, putting pressure on staff there. So something like this becomes something you really have to consider… 

It does. And the program actually has been around for three decades, since 1995...

And lots of hospitals that are doing it across the country...

Yes. With the CMS waiver, with the pandemic, it rapidly expanded across the country and we got our CMS waiver in June of 2021 and began enrolling patients in April of 2022. The waiver set out to help decrease the strain on the healthcare system due to the COVID pandemic.

And while that is incredibly important, what they also found is all of the benefits that the patients see. You know, the reason that we're doing this is not only for the patients, but also to help increase our capacity and our ability to care.

We do tend to see in this program fewer visits to the emergency department, fewer 30-day readmissions, and less utilization of our laboratory and radiology services. So, when we see those resources are not being used as much, we can kind of see a little bit of a lower cost.

What kind of future do you see for this program?

Right now, we're only taking patients with a medical diagnosis. But we're looking to expand into palliative care, end of life. You know, patients who need chemotherapy, patients who are post-surgical…

This almost sounds like somewhat of a way of the future for hospitals.

It's almost like concierge medicine, but Parkland provides it to everyone. It's a different way of practicing, and I think it will really revolutionize how we practice medicine.

RESOURCES:

American Hospital Association: Hospital at Home

Commonwealth Fund

Acute Care Delivery at Home

Parkland launches hospital at home program

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.