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Table 2 Adaptations of HaH Model

From: The effect of adapting Hospital at Home to facilitate implementation and sustainment on program drift or voltage drop

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