Helping Patients by Bringing Hospital Care to Their Homes

The COVID-19 pandemic forever changed the healthcare landscape. Among the many outcomes, patients began delaying care to avoid hospitals. According to the Centers for Disease Control, in June of 2020, more than 40% of respondents reported having delayed or avoided any medical care, including urgent or emergency care and routine care, because of concerns about COVID-19. This led many healthcare systems to examine how, and where, they deliver care to patients who need it.

The conclusion was unexpected, but simple: Patients who need acute-level care may be able to receive the same quality care in their homes, rather than in a hospital.

Meeting Patients Where They Are

Many patients admitted to a hospital need hospital-level care, but are considered stable enough to be safely monitored from their homes. For patients that have conditions with well-defined treatment protocols, such as pneumonia, congestive heart failure, diabetes or cellulitis, receiving treatment at home is preferred. It also has the added benefit of allowing for more space in the hospital for patients who need beds.

In November 2020, the Centers for Medicare & Medicaid Services launched the Acute Hospital Care At Home Program. The program allows hospitals to admit patients from the emergency department and inpatient beds to their homes. Units in this program are virtual, but patients are seen in-person daily by nurses, physicians or health paramedics.

At Northwestern Medicine, teams began to investigate how to provide the same level of patient care using the new model. A pilot screening began in January 2022, with the goal of seeing one patient through the hospital-at-home model.

New Setting, Same Care

The first patient to use Northwestern Medicine’s Hospital-at-Home Program was Diana, a 78-year-old who presented to the emergency department with symptoms related to her congestive heart failure. She was screened and admitted to a much more familiar setting the next day — her home.

Diana received two daily in-person visits from a Northwestern Medicine nurse who took vitals, collected labs and administered medications. She also received one daily visit from a physician, and while it was never utilized in Diane’s case, she had constant access to the Hospital-at-Home call line.

Four days after seeking treatment in a hospital, and three days after receiving treatment in her home, Diana was discharged where she already was — home.

Not only was the patient thrilled to receive the same medical care from the comfort of her home, the team at Northwestern Medicine saw benefits in the care model that they would not have in the hospital setting.

"By visiting her house, we learned so much about her community. We spoke with her and her daughter, and gained insight into her daily life and the stresses that she had,” says Matthew Landler, MD, hospitalist and Northwestern Medicine Hospital-at-Home attending physician. "So much of her current condition was likely related to her daily stresses and responsibilities that we wouldn’t have fully understood except by being there."

The Future of Hospital Care at Home

The pilot team is now working with Northwestern Medicine leaders to outline a plan for expanding the hospital-at-home care model across the system.

The Hospital-at-Home Program at Northwestern Medicine will change how and where patients receive the care they need while reducing costs, improving outcomes and enhancing patient experiences.