Have you ever participated in a telehealth appointment? The number of people choosing telehealth rather than face-to-face medical care has been increasing within the last several years. For many, it’s the convenience of staying at home that makes telehealth appealing, however, according to Paul Cerrato, M.A., and John D. Halamka, M.D., M.S., there are actual health benefits to telehealth and telemedicine practices. More information about these benefits can be read about in the following excerpt from Transform, which includes a range of knowledge from Mayo Clinic experts on the ever-advancing topic of telemedicine.
Advanced care at home
Telemedicine has been around for a long time, but it became much more popular when the COVID-19 pandemic started. Telecare accelerated from 3%-4% of visits in January 2020 to 90% in April, to a new normal of 20% in 2021. By one estimate, 43% of adults in the United States used such services in 2022, and that number is likely to grow over time. In 2023, the telemedicine field was valued at about $115 billion. While patients receive most of these services for relatively minor medical problems, individuals with serious needs can also benefit from care provided in the comfort of their own home.
Research has demonstrated that hospital-at-home programs for patients with specific acute medical conditions can reduce complications and reduce the cost of care by 30% or more. One of the most progressive programs to focus on this transition was spearheaded by Johns Hopkins Hospital in 1994. Bruce Leff, MD, and his colleagues tested this program with 455 elderly patients from three Medicare-managed systems and a Veterans Affairs medical center. They found that the home model met quality-of-care standards comparable to those expected of in-hospital programs.
Mayo Clinic Platform is also involved in the development of a hospital-at-home program, called Advanced Care at Home. It tracks heart rate, blood pressure, pulse oximetry, temperature, and respiratory rate in its patient population, using Bluetooth-enabled devices wirelessly connected to the Mayo/Medically Home system. It also uses tablets, a backup battery system, and a Wi-Fi phone. There are, however, critical differences between many home-care programs and the Mayo Clinic system. Many hospital-at-home programs are targeted and designed for low-acuity hospital patients. They use physician house calls as the clinical delivery model. They have a short patient engagement period (2-4 days).
The Medically Home-affiliated setup is designed to handle an extended length of stay that includes acute, post-acute, and preventive care. It uses a scalable “decentralized” model for high-acuity care and can manage a broad set of diverse use cases and support an extensive patient census. The program uses screening, training, contracting, quality management, and technology and converts “post-acute” community-based supply providers into “acute-level” providers, bringing goods and services to high-acuity patients at home while focusing heavily on the role of paramedics as the centerpiece of its ability to provide “rapid-response” capabilities. In practical terms, that means paramedics and other providers go into the home while being virtually connected with a centralized medical command center staffed by physicians who guide the care for decentralized patients and the decentralized providers who care for them.
Many of the healthcare services patients would receive in a hospital can be provided in the safety and privacy of their own homes. For example, hospital-at-home care may include meals, imaging services, blood draws, physical therapy, wound care, medicine management, and social work services. The program also provides patients with:
• A computer tablet for video visits with the Mayo Clinic care team
• A phone that connects directly to the care team
• A personal emergency response bracelet
• Vital sign monitoring devices
• A router for internet access
• A backup power supply
• Hospital-quality services such as lab tests, mobile ultrasounds and X-rays, and intravenous (IV) therapies
The service is offered at Mayo Clinic in Jacksonville, Florida, and Phoenix, Arizona, and at Mayo Clinic Health System in Eau Claire, Wisconsin. As of December 2024, the program has treated several thousand patients. Studies show that hospital-quality care at home reduced infections and falls, improved outcomes, and increased patient satisfaction while lowering hospital readmission rates.
One of the challenges in choosing a hospital-at-home service is determining who are the best candidates. Advanced Care at Home is a program for people who are sick enough to be in a hospital setting but not so sick that they need surgery, invasive procedures, or advanced imaging. People who enter the program might have an acute-level condition that requires inpatient-quality care. Examples include heart failure, pneumonia, a bloodstream infection, and bronchitis. Among the services offered:
• In-person advanced practice provider, nursing, and community paramedic care
• A care plan and schedule designed around each patient’s needs
• Pharmacy and medicine management
• Targeted individualized patient education
Additional services, as needed, may include:
• Physical, occupational, and speech therapy
• IV infusion services
• Laboratory testing
• Meals and nutrition
• Mobile imaging and ultrasounds
• Behavioral health
• Social work
• Specialty consultations
The care team is led by Mayo Clinic doctors and includes nurse practitioners, physician assistants, nurses, and other healthcare and service professionals. A patient has access to the team in the Advanced Care at Home command center anytime, day or night. The care may also include in-home visits by a nurse practitioner, a physician assistant, or other healthcare professionals, depending on an individual’s needs.
Staff members in the command center direct each episode of care in the home and coordinate with a healthcare professional who is in the home. Each episode of care is detailed in a patient’s electronic health record.
Patients may enter the program from the hospital, from the emergency department, or from a doctor’s office. Involvement with the program may include three phases.
Acute phase
Depending on the diagnosis, this phase could last up to 6 days. The care team coordinates the appointments in the patient’s home to suit their schedule. The first appointment is with a paramedic team, which conducts a home safety assessment to ensure that the patient has a setting suitable for this type of care. This includes a stable internet connection, running water, and sufficient space to limit the risk of falling.
The paramedics also set up equipment they need and coach the individual on how to use it. Examples are a computer tablet on which they will hold video meetings with the care team, a router to provide internet service, various devices for remote monitoring of vital signs, a personal emergency response system (PERS) device for rapid response, and any needed durable medical equipment. After this first visit, the team visits the patient’s home each day to address their care needs, which may involve infection control, respiratory therapy, and infusions.
Restorative phase
During the next 25 to 30 days, the patient may be enrolled in remote patient monitoring. Vital signs are remotely monitored through connected devices, and the patient has access to the care team by video.
Return to primary care
When a patient is discharged from the Advanced Care at Home program, follow-up care is then provided by their usual primary care team.
Additional details about the program, including insurance coverage, are available on the program’s website: Advanced Care at Home
An excerpt from Transform by Paul Cerrato, M.A., and John D. Halamka, M.D., M.S..
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