Like many health systems across the United States, Pinehurst, North Carolina-based FirstHealth of the Carolinas has a problem with bed rest and is always working on new and innovative ways to increase the safe and reliable financial system.
PROBLEM
This has been done through a number of different sources. FirstHealth’s extended care facility at its Richmond campus is, among others, a brick-and-mortar solution, while the home observation program (OAH) helps address complex, but virtual, issues.
PRINCIPLE
The OAH program is designed to help increase bed capacity throughout the health system by releasing stable patients who can be managed at home through the program but would have to stay in a hospital if treated with traditional medicine.
OAH provides a number of medical facilities on behalf of some permanent bed-bound patients. After patients are referred to the program, a health care provider will visit them at their home the next day – with exceptions sent from home health, which I will explain in a moment – where they will do the analysis that includes the vital signs.
Once the assessment is complete, the health care provider contacts the client to complete the remainder of the visit via secure video teleconference. FirstHealth uses Epic for these sessions. Although medical care is available in the patient’s home, the provider evaluates the patient by video-telephone and includes input from the assistant to continue the patient’s care. During this visit, the agent can order drugs or labs.
Note, agents do not use an ambulance for this program.
The provider will also determine if the patient needs to be seen again, or if they are stable enough to be discharged from the program. The goal of the OAH program is to help patients manage their disease. The average length of stay in the program is just over three days.
After being released from the OAH program, patients who are already enrolled in home health care will continue these visits. If the patient is not registered for home health, they are transferred to the home care program (VCAH). The program uses remote patient monitoring using tools from Health Recovery Solutions so that staff can track the patient’s vital signs for days to weeks.
Patients also have a registered nurse via telephone if needed while in the VCAH. The VCAH program is offered at no cost to the patient and is part of a broader effort to improve bedside management.
The staff sees patients with the following illnesses but can evaluate others on a case-by-case basis: CHF, COPD, pneumonia, influenza, COVID19, asthma, the need for IV antibiotics, cellulitis evaluation and recurrent abdominal pain.
Patients can be referred to OAH in a variety of ways:
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Patient referrals. Permanent patients are referred to OAH by the medical team. These are patients who are stable and are enrolled in the OAH program to continue the remaining days of care that would normally be spent in the hospital.
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Referral to emergency department. Regular patients who would normally have been admitted to the hospital’s observation room for a variety of reasons can now be discharged from the OAH program.
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Home health. Patients with a family history of the disease may have severe complications. These are stable patients, but who would normally have been referred to the ED for further education or treatment. About 80% of patients referred to the ED by home health care are admitted for evaluation. OAH is now a home health option for their regular patients to be seen instead of sending them to the ED. Patients with cardiac, pulmonary, neurological or other chronic complaints are still referred to the ED immediately via 911. Patients seen in OAH from home health referrals are more likely to have COPD, patients with CHF who are overweight or have respiratory problems. but not breathing, or patients with respiratory disease requiring further evaluation. For these patients, staff can intervene early in the exacerbation and help prevent the patient from needing to go to the ED. Patients referred to OAH are usually seen on the same day as referrals.
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Basic assistants or assistant assistants. PCPs or qualified providers can also refer patients to OAH, where they are seen the next day, ensuring that their plan of care is effective and that the patient is doing well, and that they can continue to provide care that they would not otherwise receive without referral. in the ER. Most referral staff see from a PCP and the appropriate care is the prevalence of COPD and acute respiratory infections such as COVID-19, influenza or pneumonia in high-risk groups.
FACING A PROBLEM
“We finish ours telemedicine video visits using Epic EHR,” said Stephen Kapa, ​​director of telehealth operations at FirstHealth of the Carolinas. “All information is provided through the platform. For patients transitioning to the VCAH program, we use Health Recovery Solutions blood pressure cuffs and pulse oximeters. The patients download an app from the vendor to their phone and can upload their readings from their monitoring devices through the app.
“A nurse monitors them every day and calls patients directly if someone has important symptoms,” he said. “Patients can also call the nurse directly with any concerns. In some cases, we need to initiate tele-video visits where patients are re-enrolled in the OAH program or are advised to go to the ED.”
FirstHealth has found that keeping things simple is the best strategy, and has been working since the COVID-19 pandemic. Often times, the more complex things are created, the more complex they become, resulting in many unusable processes – keep things simple, Or he added.
RESULTS
“One of the biggest things we’ve done in the last 14 months is the increase in daily registration,” Kapa said. “Our financial year runs from October to October. In the first week of October 2023, our daily registration was at least two. We have had our peaks throughout the year, but the trend has always been good. In the past. week of our year money, we had 13 patients a day.
“This has had a significant impact on patient access and sleep quality as well as patient satisfaction and staff productivity,” he said. “We expect daily enrollment to continue to rise, especially with the positive volume of patients in the winter months.”
Another success employees enjoy is their increased 30-day heart failure rate and all-cause mortality.
“The average 30-day rate of people with heart failure and recurrence for each cause is about 20% and 14.5% respectively,” said Kapa. “For patients who are admitted to the OAH program, the rate of heart failure and recurrence is below 10%. Although this represents a cost saving, the most important thing is that it shows that we can care for patients with the OAH program carefully and efficiently. .
“Finally, the thing we can’t do is appreciate the patients and families who are grateful to receive their care at home instead of being hospitalized,” he said. “We have had words of gratitude and appreciation for what this program has done to help them stay where they are most comfortable – at home.”
ADVICE TO OTHERS
“My advice is twofold,” said Kapa. “Keep things simple and persevere. As you can see from the growth of our daily registration, it is not just growing up or on its own. You have to be very persistent in delivering your message about the program to all. groups, especially providers and those preparing to release.
“From a provider’s point of view, many have been using drugs for some time,” he said. “They are used to doing things in an orderly and traditional way. I am a physician assistant by training, so I understand this. Giving them the opportunity of the OAH program gives them another opportunity that did not exist. The need is to persevere and share success stories, as little as it may be in the beginning.”
And attend as many meetings as possible, he added.
“Go to rollout meetings, go to different groups, talk about the program wherever you can,” he concluded. “Once providers start to see the benefits of this program, make sure their patients are getting the best care and see the number of readmissions go down, it will take its toll. I believe we are at the end of this era. Now.”
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