Adaptations | Rationale | Quarter of Initiation |
---|---|---|
Addition of 30-day post-acute transition component to the HaH model | To improve transitions of care, reduce preventable readmissions, and establish follow up with primary care | 0 (inception) |
Expansion of original target diagnoses and reduce exclusions (e.g., HIV exclusion) to reflect current medical practice | To enroll patients with a broader set of diagnoses who could be safely treated at home, per clinical judgment | 1 |
Implementation of Palliative Care Unit at Home | To provide acute services at home consistent with stated goals of care for patients with advanced illness who would otherwise have been excluded from HaH | 1 |
Collaborated with community paramedicine program to consult with HaH physicians by video for patients needing urgent visits in the home | To better evaluate and address urgent clinical needs and avoid unnecessary visits to the emergency department | 1 then suspended due to bankruptcy of partner and restarted in 6 with new partner |
Contracting for infusion services | To increase staffing flexibility in being to provide infusion services | 2 |
Dedicated nurses hired | To increase availability and consistency of nursing staff for the program | 2 |
Implementation of Observation at Home | To treat patients with observation services at home with the expectation that some of these patients would require more extended HaH services | 3 |
Implementation of Rehabilitation at Home | To treat patients who would otherwise require admission to a subacute rehabilitation facility in the home setting | 3 |
Expansion to new sites for enrollment along with developing new intake procedures customized for each site | 3, 6, and 9 | |
Adaptation of intake procedure for patients identified to need HaH services late at night by holding the patients overnight in the emergency department and transferring home in the morning | To capture and enroll patients presenting to the ED overnight | 4 |
Launch of telehealth visits to supplement home visits | To increase the frequency and efficiency of clinician contacts in the home | 4 |
Internalized major portions of pharmacy and lab services | To speed availability of services to be provided to patients in the home | 4 |
Implemented new version of electronic medical record | To update an earlier version of a HaH-specific electronic medical record to improve documentation and communication | 6 |
Dedicated physical therapist hired | To increase availability and consistency of physical therapy services for the program | 6 |
Role created for nurse care coordinator | To triage patient needs and coordinate staff involved in home visits | 8 |
Piloted weekend admissions | To increase service hours | 8 |