ED in Home allows patients with participating providers to be triaged, evaluated, and treated in the safety and comfort of their homes; Nearly 5,000 patients treated to date
BOSTON, Jan. 10, 2023 /PRNewswire/ — Medically Home today announced ED in Home, a groundbreaking program to bring emergency department level care to patients at home. ED in Home is another example of Medically Home advancing the movement to safely decentralize care to the home. Medically Home designed its model of care delivery for patients with serious or complex illness, bringing hospital-level care to patients at home and making it possible to easily expand to other high-acuity use cases, including emergency-level care for patients.
Medically Home’s ED in Home program was designed by leading emergency care physicians with the goal of expanding access to care for medically complex patients experiencing acute exacerbations of illness who would otherwise seek care in a brick-and-mortar emergency department. Introduced on a limited scale in July of 2020, ED in Home is available now through participating health systems in Boston and will be available in several other regions around the country in 2023.
While screening out for trauma, stroke, acute coronary syndrome, and patients needing immediate life sustaining care, the program is designed for those patients who truly need emergency department level service (versus those using a traditional hospital emergency department for urgent care). Patients treated in Medically Home’s program are sicker on average than patients accessing traditional hospital emergency rooms.
In addition, because many of these patients have a high probability of being admitted as an inpatient to the hospital (over 40% probability, on average), Medically Home’s advanced treatment approaches result in patients in ED in Home being less likely to need ongoing hospital care (vs. a control group receiving care in a hospital emergency department).
“By beginning in the home, we can safely keep very sick patients in the home, thereby reducing hospitalizations and providing a higher quality and satisfactory experience for the patient,” said Dr. Evan Berg, Chief of Emergency Medicine, Medically Home. “Our model of care also has advantages for health system entities, including physician groups, hospitals, and payors. It enables the right level of care to be matched to the right clinical condition at the right time and at the right cost. This helps health systems currently grappling with challenges of access, capacity, clinical staffing, and costs of care. Hospital emergency departments are the right place for patients with life or limb threats and those in need of immediate procedures or interventions. With our model, most other high acuity care can and should be delivered safely in the patient’s home.”
How it Works
Patients are either referred by their PCP or may self-refer:
- A triage nurse evaluates the patient within minutes by phone and determines whether 911 activation is needed or if the patient is stable enough to wait to be seen at home.
- A specially trained paramedic or nurse arrives in the home within two hours and begins the assessment.
- The paramedic or nurse is linked to an emergency medicine physician by video.
- The paramedic or nurse performs lab tests including bloodwork, urine testing, rapid COVID and flu swabs, receiving results at bedside.
- The paramedic or nurse carries a wide array of medications, antibiotics, and fluids.
- Mobile imaging capabilities are available, including point of care ultrasound and bedside x-ray
- Emergency Physician determines an appropriate disposition plan after evaluation and management. Based on clinical needs, this can include a conclusion of the ED in Home encounter, admission to hospital-at-home or 911 escalation to a brick-and-mortar Emergency Department.
- All encounter notes and data are shared with the referring clinician
- All patients receive a next day clinician phone call to reinforce after visit plans (e.g., medication changes), review next steps in care and re-assess clinical status
Together, this allows for the timely evaluation and management of high acuity conditions commonly seen in hospital emergency departments. Of the nearly 5,000 patients seen in this model:
- 81% of patients remained at home without requiring transfer to a brick-and-mortar hospital for further evaluation
- Hospital admissions were reduced by 45% to less than 25% of patients needing hospitalizations
- Patient and provider satisfaction reports are higher than the average brick-and-mortar emergency department patient satisfaction scores
Medically Home’s ED in Home program is a natural extension of its hospital-at-home (HaH) programs which are in operation with leading health systems around the country.
“When necessary, patients can be directly admitted to hospital-at-home from the in-home emergency department and may avoid a facility altogether,” said Dr. Meghan McGrath, Senior Medical Director, Medically Home. “There are benefits to staying out of the hospital — reduced serious falls and reduced hospital acquired infections in addition to improved patient outcomes. ED in Home is the next frontier of emergency medicine.”
Medically Home’s ED in Home program is especially beneficial for older patients who may fear traditional hospitals or who don’t want to lose autonomy or connection with family, those who are home-bound or struggle to reach facilities. In addition, it can relieve strain on an overcrowded emergency department and reduce costs for physician groups involved in value-based contracting, Accountable Care Organizations (ACOs), and insurers.
“Groups ready to bring ED in Home to their patients are driven to provide the right care for patients in the places they choose,” said Dr. Doug Clarke, Service Line Leader of ED in Home, Medically Home. “There is a growing understanding that the default site of care should be the home to improve patient care while decreasing overall costs to the system. Medically Home is commercializing this capability nationally, making it possible for more patients to receive care in their living room rather than lingering in a waiting room.”
“Medically Home’s model for safely treating serious or complex illness at home has redefined patient care,” said Rami Karjian, Co-Founder and Chief Executive Officer, Medically Home. “ED in Home is the next logical step in advancing high-acuity care at home. As the rest of the burgeoning care at home market starts with low acuity care and works to move up the continuum to add use cases, we designed Medically Home’s model for the sickest patients. Having developed the tools and resources to care for those with serious, complex or high-risk illness at home, we are adding other patient populations and geographies to forever change the way that care is delivered for the most complex patients.”
About Medically Home
Medically Home operates a decentralized care model for patients with serious, complex or high-risk illnesses in partnership with health systems to safely care for their patients at home, across the care continuum, including hospital-level care. Medically Home provides health systems with all that is needed to safely care for patients, including the clinical protocols, reimbursement model, platform technology, and fulfillment of all the clinical services required in the home through partners. Clinicians and patients broadly prefer this model over traditional care; both clinical and financial outcomes are improved as compared to traditional care. For more information, visit www.medicallyhome.com.