How FirstHealth improves outcomes with home monitoring

Like many health systems across the United States, Pinehurst, North Carolina-based FirstHealth of the Carolinas has a serious sleep problem and is constantly working on new and innovative ways to address it. increase in a safe and financially responsible way.

PROBLEM

This is done in several different places. FirstHealth’s extended care unit at its Richmond campus is, among others, a brick-and-mortar solution, while the home observation (OAH) program helps with capacity issues, but only partially.

ATTENTION

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 need to stay in the hospital if they were cared for by traditional medicine.

OAH offers many organizations in the health system an alternative for some stable patients who are bedridden. Once patients are referred to the program, a health care professional will visit them at home the next day – exceptions are a referral from home health, which I will explain in a moment – where they will do an individual assessment that includes vital signs.

Once the assessment is complete, the emergency physician connects with the provider to complete the remainder of the visit via secure tele-video. FirstHealth uses Epic for these sessions. While the health care professional is present in the patient’s home, the provider examines the patient via tele-video and incorporates feedback from the medical doctor to continue caring for the patient. During the visit, the provider may order medication or a lab.

Please note, paramedics do not use an ambulance for this program.

The provider will also decide if the patient needs to be seen again, or if they are stable enough to be released from the program. The mission of the OAH program is to help patients overcome the acute phase of their illness. The total length of stay in the program is just over three days.

After discharge from the OAH program, patients already enrolled in family health will continue those visits. If the patient is not enrolled in home health, they will be referred to a home care program (VCAH). The program uses remote patient monitoring and equipment from Health Recovery Solutions so staff can track a patient’s vital signs over the next few days and weeks.

Patients also have access to a registered nurse by phone if needed while at VCAH. The VCAH program is offered at no cost to the patient and is part of a larger effort to help manage bed capacity.

Staff sees patients with the following diagnoses but may screen others for specific conditions: CHF, COPD, pneumonia, influenza, COVID19, asthma, need for IV antibiotics, cellulitis diagnosis and pain assessment they are in the stomach.

Patients can be referred to OAH in a number of ways:

• Patient referrals. Stable patients are referred to OAH by the hospital team. These are patients who remain stable and are enrolled in the OAH program to continue the remaining few days of care that would normally be completed in a hospital bed.

• Emergency department referrals. Stable patients who would normally have been admitted to a hospice for various reasons can now be admitted to the OAH program.

• Healthy home life. Patients enrolled in family health care who may have a serious presenting problem. These are stable patients, but who would normally have been referred to the ED for workup or treatment. About 80% of patients referred to the ED by family health are admitted for evaluation. OAH is now an option for family health for their stable patients to be seen instead of sending them to the ED. Patients with potentially life-threatening cardiac, pulmonary, neurological, or other potentially life-threatening complaints are sent to the ED immediately by 911. seen in OAH from referrals by family health tend to start increasing COPD, CHF patients with weight gain or increased breathing but not depressed, or patients with infections high respiratory rate that requires further examination. For these patients, staff can intervene early in an exacerbation and help prevent the patient from needing to go to the ED. Patients referred to OAH are usually seen on the same day of referral.

• Primary care providers or appropriate care providers. The PCP or other appropriate care providers can also refer patients to the OAH, where they are seen the next day, and ensure that their plan of care is working well and the patient is improving, but also continuing. providing care that they may not have received unless referred. in the ER. The main drivers of referrals to PCP and simple care are the prevalence of COPD and severe respiratory diseases such as COVID-19, influenza or pneumonia in vulnerable populations.

MEET THE PROBLEM

“We’re finishing ours telemedicine video visits using Epic EHR,” said Stephen Kapa, ​​director of telehealth services at FirstHealth of the Carolinas. “All information is transferred through that platform. For patients transitioning to the VCAH program, we use Health Recovery Solutions blood pressure cuffs and pulse oximeters. Patients download the app from the vendor to their phone and can enter their readings from their monitoring devices into the app.

He continued: “The nurse monitors them every day and calls the patients directly if someone has important symptoms. “Patients can also call the nurse directly with problems. whatever. Sometimes, we need to initiate a tele-video visit where patients are re-enrolled in the OAH program or referred to the ED.”

FirstHealth has found that keeping things as simple as possible is the best strategy, and it has worked since the COVID-19 pandemic. Often times, the more complicated things become, the more complex they become, the more steps they take to implement – keep things simple, Or added.

RESULTS

“One of our biggest achievements in the last 14 months has to be the average daily number of people on the show,” Kapa reports. “Our fiscal year runs from October to October. In the first week of October of 2023, the number of people per day was less than two. We had peaks and troughs’ o ours throughout the year, but this trend has been good. During the week of our fiscal year, we had 13 patients a day.

“This has had a significant impact contributing to increased patient access and bed capacity as well as increased patient satisfaction and engagement,” he continued. “We expect the average number of daily visits to continue to rise, especially with the usual increase in the number of patients during the winter months.”

Another achievement that staff are very excited about is the 30-day readmission rate for heart failure and all causes.

“The overall 30-day rate of heart failure and relapse is about 20% and 14.5% respectively,” Kapa noted. “For patients admitted to the OAH program, the percentage of both heart failure and all-cause readmissions is less than 10. Although this represents cost savings, it is even more important to show that we able to safely and effectively care for patients with OAH.

“Finally, a unique step we cannot maintain is the appreciation of patients and families who are grateful to receive their care safely at home instead of being admitted to a hospital,” he added. “We’ve had so many words of gratitude and appreciation for what this program has done to help them be where they’re most comfortable – at home.”

ADVICE FOR OTHERS

“My words are twofold,” Kapa said. “Keep things as simple as you can and persevere. As you can see from the average daily population growth, it didn’t grow overnight or by itself. .You need to be persistent in getting your message out about the program to everyone, especially donors and producers.

“From a client’s perspective, many have been in medicine for a long time,” he continued. “They’re used to doing things in a formal and traditional way. I’m a physician’s assistant by training, so I understand this. Giving them the option of the OAH program gives them another option that normally isn’t there. the need is to pursue and share success stories, as little as possible at first.

And attend all possible client meetings, he added.

“Go to discharge planner meetings, go to interdisciplinary rounds, talk about the program wherever you can,” he concluded. “When providers start to see the benefits of the program, see that their patients are being cared for safely and see readmission rates go down, this will pay for itself. I hope we’re on the right track.” this last one. now.”

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