Humanizing healthcare with Hospital-at-Home

Coauthored by Sandy Andrews, SVP, Innovation and Strategic Services, Press Ganey.

Hospital-at-Home (H@H) is an emerging healthcare delivery model that aims to provide high-quality, hospital-level care in the comfort of a patient's home. Advances in infrastructure and technology have made this possible—including portable continuous monitoring systems; 24/7 virtual care centers; a skilled, seamlessly connected, mobile healthcare workforce; proven clinical pathways with real-time alerting; and a payment structure making the work sustainable.

The nascent Hospital-at-Home movement got a boost in 2020–2021, during the capacity crisis caused by COVID-19. Healthcare systems had to act quickly to innovate care models to serve all patients in need. From quaternary healthcare centers to rural community hospitals, leaders swiftly created pandemic playbooks—which included how to deliver high-quality acute care outside their four walls.

I know this, because I was one of them.

As the President and Chief Clinical Officer for Providence St. Joseph Health, I was responsible for clinical care outcomes. I vividly remember the day we admitted the country’s first COVID-positive patient at our Everett, Washington, hospital. From that day forward, we went from scenario planning to capacity challenges. We leaned in quickly. From setting up outdoor tents for testing and triaging patients to creating home monitoring solutions and nurse oversight, we rapidly innovated efficient and safe ways to deliver acute care at scale outside of the hospital.

I’ve often said that the pandemic fueled an enormous leap forward in the future of medicine. Moving Hospital-at-Home past the pilot stage to being broadly available is one of the rare silver linings from a once-in-a-century healthcare disaster.

By creating Hospital-at-Home models, we are, in a sense, going back to the future. Before the mid-20th century, care was often delivered in one’s own home, with family and friends nearby, and a bed where the patient could sleep comfortably at night. But we moved away from this model as new, cutting-edge medical technology was developed. This technology was primarily accessible in hospitals, supported by 24/7 expert medical care. In the transition, we centralized patient care into large buildings. And while so many lives are saved within these buildings, they tend to be brightly lit, bustling, frightening, and (despite everyone’s best intentions) institutional feeling.

With Hospital-at-Home, we’re now seeing what Clay Christensen described in The Innovator’s Prescription: a move from centralization to decentralization. It’s moving care outside the hospital walls, back into where we, as human beings, would prefer it to be: at home. And the healthcare workforce—people who dedicate their lives to making others’ lives better—can see how well this works, and they seem to enjoy caring for patients in their homes.

Technological advancements have enabled this decentralization, and our communities have gained trust in these capabilities after their rapid deployment during the pandemic. At a time of rampant burnout in healthcare, care models that help patients, engage the workforce, and positively serve our communities all at the same time are a huge win. And we now have a recipe for success.

In my current role as President and Chief Clinical Officer of Press Ganey Consulting, I’ve had the opportunity to connect with many health systems around the country that are actively running Hospital-at-Home programs. With the Press Ganey Human Experience platform as the engine, we’ve aggregated data across 25 leading health systems to measure 4,000+ H@H encounters. And the data is very promising.

Measuring healthcare experience in a Hospital-at-Home setting

Patient experience is a critical component of healthcare quality. When we’re ill, we want to be treated not only with skill, but with respect and compassion as well. Healthcare is complex. Being ill is frightening. And having confidence in the care team is essential for the best possible outcomes. Organizations that integrate measures across patient experience, workforce, and safety not only advance care outcomes more effectively, but they improve their margins while making health and care better for all.

The Press Ganey standard inpatient survey measures the inpatient care experience. For patients who receive part, or all, of that hospital-level care in their own home, we developed a H@H pilot survey specifically to measure the patient experience in this setting. Press Ganey data from 25 health systems that have implemented the Hospital-at-Home survey reveals that experience scores are significantly better for patients in the program vs. patients in traditional hospital rooms.

The table above shows the customized question regarding “time doctors spent with you during your hospital care at home stay” across the 25 organizations using H@H. The mean score was 91.09 out of 100, whereas a similar question for standard hospital experience (“time doctors spent with you during your hospital stay”) was 81. That's a 10.1-point difference. If a traditional hospital achieved a 91.09 on “doctors spent time with you” on their inpatient survey, they’d be in the 98th percentile of performance. 

Similarly, in the table below, when comparing patients’ likelihood of recommending their hospital program, H@H exceeded industry means.

Our data aligns to other studies suggesting that the patient experience in Hospital-at-Home programs is generally positive. Now is the time to broadly track and measure care programs outside the hospital to establish benchmarks, create industry standards, and learn what drives optimal performance.

Understanding variability in H@H programs

The Hospital-at-Home survey measures the experience of receiving hospital-level care within a patient’s own home for high-acuity conditions that require telehealth, remote monitoring, and regular in-person visits by nurses, doctors, and/or advanced practitioners. As a clinician myself (and having led healthcare organizations with more than 25,000 physicians), I recognize the variability that exists across programs, geographies, and local resources. More research is necessary to understand the barriers around broadly operationalizing Hospital-at-Home programs. Are the steps to transfer patients from one care setting to H@H more difficult in some places than others? Are clinicians more comfortable for specific diagnoses (diagnosis-related groups, or DRGs) for at home care? What fears do patients, families, and their clinicians need to overcome? Is there a different level of patient-caregiver trust needed to ensure acutely ill patients can effectively be treated in their home?

For the 25 healthcare systems engaged in our research, we evaluated what DRGs were most common to better understand trends in conditions more suitable for hospital at home admissions. The top diagnoses, based on the patients surveyed, were:

As a clinician, when I see this list, I recognize conditions that have well-established clinical pathways, and I imagine the care teams are confident that treating the patient in the home setting is both safe and the right approach. This list overlaps with some of the most common diagnoses for which patients are admitted to inpatient facilities. Knowing this, I’m hopeful we can continue to study the longer-term clinical outcomes and rapidly learn how to safely scale these human-centered care programs.

Measuring caregiver experience from all sides

Healthcare worker experience is also an essential aspect of measuring the end-to-end success of Hospital-at-Home programs. While we don’t have off-the-shelf measures that look at this directly, we know there's a tight correlation between employee engagement and patient experience. The data suggests that care providers are engaged by working in this care model. Standard Hospital-at-Home surveys contain questions evaluating care that can be compared to traditional hospital stay experience questions. Again, patients perceive caregivers more positively when in the Hospital-at-Home setting—as evidenced below.

Measuring caregiver experience directly in the Hospital-at-Home setting can be challenging due to many factors, including the lack of standardized tools and the diversity of caregivers' needs and preferences. But, as the data above demonstrates, patients feel clinicians are more empathetic and better communicators when care is received at home.

Press Ganey has partnered with health systems for decades to drive improvements across the entire continuum of care. And from this extensive experience, we know just how important it is to establish clear and comparable measures—measures that help us understand drivers of engagement, alignment, and resilience. Developing that validated tool evaluating the caregiver experience at home, compared to in the hospital for similar patients, remains a work in progress—but one we resolutely dedicated to. Together, with our deep clinical expertise, technology, and measurement know-how, we strive to collect the data that will illuminate best practices for this win-win model of care.

As we strive to humanize healthcare, we must turn to and support groundbreaking innovations that are proven to work like Hospital-at-Home. Hospital-at-Home programs are making acute care available to patients where they live—and, as we’ve shown, the results are encouraging.

Press Ganey partners with our clients to track and measure the Human Experience (HX)—across patients, their families, caregivers, and clinicians—using a single HX platform. Measuring patient and caregiver experience in Hospital-at-Home programs is a critical aspect of healthcare quality, and it requires a partnership of experienced clinicians, administrators, technologists, and patients. And we need a comprehensive collaboration between new care delivery models and other like-minded technology companies to achieve just that. By learning faster together, we can drive deeper innovation, gain insight from cross-organizational patient care in the Hospital-at-Home space, and propel the industry into a new and improved era of healthcare.

Let’s join forces to co-create solutions that help us rapidly innovate, implement, and improve new models of care. Our teams can work with yours to track and measure Hospital-at-Home success factors and pain points, analyze data, and develop scalable and sustainable solutions that address the challenges faced by patients and healthcare providers alike.

For a personal conversation about your organization’s unique needs, and how Press Ganey can help you achieve your goals, schedule some time with our strategic consulting team.