One large health system successfully employed a hospital at home program during the COVID-19 pandemic using remote technology and a multidisciplinary team.
“At Kaiser Permanente, one of our strong suits is we’re an integrated model, and we have the ability to pull people together quickly,” says Dan Huynh, MD, regional assistant medical director and regional hospitalist for the Southern California Permanente Medical Group.
By the end of 2021, the program had built a strong central team to support 13 medical centers across California.
This is how the program worked:
• Simplified technology. Patients downloaded an app to their own phones instead of a tablet provided by the health system, says Earl Quijada, MD, FACP, a physician in geriatric, palliative, and continuing care at Southern California Permanente Medical Group.
“We made it disposable, so what patients got in their home, they could keep it in their home,” Quijada says. “We made it really easy.”
Without Bluetooth technology, the costs were lower. The tradeoff was patients or their caregivers had to type in the values.
• Home kits. “We sent patients home with a COVID kit that required remote monitoring, and it was the first time that any large health system had leveraged remote monitoring in this capacity,” Huynh explains. “It included a thermometer and a pulse oximeter to monitor oxygen levels, which is the most critical piece of vitals we could follow for COVID patients. The pulse oximeter also monitored heart rates.”
• Remote communication. Healthcare staff communicated through a software app and monitored patients 24/7. A multidisciplinary team was involved, including enrollers, who helped obtain patients’ information and registered them to receive the remote monitoring devices and kits.
The case management team or COVID home monitoring team called patients automatically on the first day of enrollment. The team sent information to patients and instructed them to download the app and learn how to use it. The team also contacted patients if their temperature or pulse oximeter readings indicated a problem.
“They’d get a phone call if they didn’t enter anything into their app,” Quijada explains. “There were a lot of safety measures we put in.”
The safety measures worked well, quickly identifying patients who needed help.
• Monitored adherence. “Patient engagement has been a struggle through virtual care, but we learned automation capabilities to strengthen that adoption,” says Alyssa Millan, MPH, senior manager of health innovation at Southern California Permanente Medical Group. “We use a hybrid model of a personal test with a care team member and a technology piece that empowers patients to take ownership of their own care.”
Also, “nudging” capabilities would create a push notification for a patient adherence alert to remind patients to enter their oxygen saturation numbers.
“The notification is an alert on their app that says, ‘It’s time to enter your survey information and your vitals,’” Millan says.
• Maintained staffing levels. The biggest and most immediate amplifier for the health system’s capacity during the pandemic was the use of video and phone visits, says Angel Vargas, FACHE, vice president of Care at Home of Kaiser Permanente Southern California and Hawaii.
“We didn’t hire a boatload of new staff,” Vargas says. “We maintained capacity with the staffing we had and our external network.”
EDs were challenged by the pandemic. “When the COVID surge hit, the first place we saw the big surges was in the ED,” Huynh says. “Patients become short of breath and have trouble breathing, so the majority go to the ED. This is where we had an opportunity to make a clinical decision of whether we could care for patients safely at home or admit them to the hospital.”
At first, COVID patients would be admitted for five to 10 days. But once the home monitoring program was fully implemented, many of these patients were safely discharged to home sooner.
“We wanted the highest care for our patients, quality care at home, and we were not causing harm,” Huynh says. “We created capacity because otherwise the hospitals would be overwhelmed, particularly with the third surge.”
Data showed the program worked. In addition to safely managing patients at home, researchers found patients reported a high rate of satisfaction with the program.1
“We surveyed patients around their ability to navigate the program, and their sense of safety and wellness and connecting with the teams, and patients were very satisfied with the program,” Huynh says.
Adherence to treatment protocols was greater than 90%. “We ran data around mortality and adverse impact, and this program did not show any evidence to suggest there was any adverse impact,” Huynh says. “In fact, there were data leaning toward improved mortality. There were a lot of benefits on this approach.”
REFERENCE
- Huynh DN, Millan A, Quijada E, et al. Description and early results of the Kaiser Permanente Southern California COVID-19 Home Monitoring Program. Perm J 2021;25:20.281.
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