Days spent at home in the last 6 months of life has in recent years been proposed as a highly patient-centered quality measure: It focuses on what patients want. The focus on days at home arises from the recognition that reductions in hospital length of stay have come at the cost of more frequent discharges to and more days spent in subacute nursing and rehabilitation facilities, sometimes in a vicious cycle, leading to longer times spent away from home. This defect in the health care system is structural: Inter-facility transfer is seen by many as a feature, not a defect, of the system. Hospital at Home (HaH), a model of care that provides hospital-level care in a patient’s home in lieu of traditional hospital care for patients who are not enrolled in hospice, provides an opportunity to resolve this defect and improve patient experience and quality of care. In 2015, The Mount Sinai Health System implemented HaH-Plus through a Center for Medicare and Medicaid Innovation (CMMI) Health Care Innovation Award. HaH-Plus supplements acute HaH services with 30 days of post-acute transition services. Similar to previous studies, compared with control patients who received traditional hospital care, those who received HaH-Plus care had decreased readmissions, delirium, falls, and hospital-acquired infections, as well as better patient experience…..more
