ARTICLE: Why I Believe in Hospital at Home

AUTHOR: Bruce Leff

JOURNAL: N Engl Med. 2015 Dec 21

As a medical resident in the late 1980s, I made house calls to homebound older adults in Baltimore. I loved seeing patients and their families in their own space, thinking about their medical issues in that context, relying a bit more on my physical exam than I did in the hospital, and developing care plans consistent with patients’ preferences. I was a trusted guest in patients’ homes — being on their turf gave them power over their care.

When these homebound elderly patients got sick, some flat out refused to go into the hospital — patients with pneumonia or exacerbations of chronic illness, even heart attack or stroke. As one amiable Baltimorean told me, “Doc, you guys are wonderful, but you run a crappy hotel.”

I witnessed that reality when I was on inpatient service: terrible food, schedules driven by providers’ (not patients’) needs, the impossibility of sleep, and maladies galore related to being in the hospital — delirium, falls, functional decline, and so on. In my own practice, I sometimes wonder if hospitalizing a particular patient will confer more harm than benefit.

These experiences prompted us at Johns Hopkins to ask, 20 years ago, “Could acute medical illness that normally requires hospital admission be well managed in a patient’s home instead?” The result was Hospital at Home (HaH) — an option for some patients with community-acquired pneumonia, exacerbations of heart failure or chronic obstructive pulmonary disease, cellulitis, and (recently) other conditions. And HaH is still going strong today.

For a link to the full article, click here: http://catalyst.nejm.org/why-i-believe-in-hospital-at-home/

The article is also available on the Harvard Business Review: https://hbr.org/2015/12/a-vision-for-hospital-at-home-programs

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