Original publication date: January 2024
We are kicking off 2024 by featuring Dr. David Levine of Ariadne Labs. Dr. Levine and his colleagues are exploring how home hospital care can be part of addressing some of our most pressing challenges, including rural healthcare, mental health, and care for people experiencing homelessness. Earlier this month, he joined us to share more about his work in the Power is a Social Determinant of Health series. We invite you to watch the recording linked below. In this issue we also introduce you to a few new grant partners in our network; and share resources, jobs, and upcoming events from colleagues and partners.
A Tool to Make Hospitalization More Equitable
Watch: A Power is a Social Determinant of Health webinar with Dr. David Levine (pictured above) on home hospital
Trade Offs Podcast
Listen: Episode on “How the Loss of a Rural Hospital Compounds the Collapse of Care”
KFF Health News
Read: Lauren Sausser’s “Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions”
Since 2005, it’s estimated that over 100 rural hospitals have shuttered. As a result, more than 60 million Americans who live in rural communities face diminished access to healthcare and poorer health outcomes.
In Tennessee alone, 13 rural hospitals have closed since 2010. Rural residents, who are often older and have more chronic health conditions requiring monitoring and treatment, face a multitude of burdens when trying to access acute care. Without readily accessible hospitals in their counties, low-income residents, the elderly, chronically ill, and mothers and newborns have to travel up to 60 miles away for specialty or emergency care, or experience extended ambulance times. As one rural Tennesseean shared with the Tennessee Health Care Campaign, “the ambulance is our emergency room”.
As rural hospitals continue to close across the country, medical researchers and healthcare providers are considering alternative options for providing acute care to patients outside of hospital walls. One proposed alternative is acute care at home.
More than 300 home hospital programs around the country are deploying hospital-level care at home to not only treat an acute illness but also to treat social determinants of health in the most effective place – a patient’s home. Treating over 75 general conditions like pneumonia, complicated UTIs, cellulitis, and even heart failure, home hospital care has been proven to be safer and more cost-effective than a patient’s admission to a hospital. For instance, patients enrolled in home hospital care were found to have a 24% reduction in readmission rates and 21% reduction in mortality rates compared to those admitted. Even more so, a patient’s functioning status, satisfaction, and comfortability are markedly improved when they receive care in their home.
One such home hospital program in Utah was developed in partnership with researchers at Ariadne Labs, led by Dr. David Levine, a physician at Brigham and Women’s Hospital in Boston, MA. With support from the Rx Foundation, in 2019, Ariadne Labs launched a Rural Home Hospital program to test whether home hospital models could be adapted for rural healthcare settings.
Dr. Levine and his collaborators conducted a feasibility pilot of rural and ultra-rural home hospital care in Utah, the goal of which was to advance the development and use of new care models in communities that face geographic barriers to accessing acute care, especially that of rural communities. Ariadne Labs partnered with the University of Utah Health system to test the model in two remote communities and measure health outcomes.
Since then, Ariadne Labs and Dr. Levine discovered that “moving the site of acute care to the home” is a promising, safe, cost-efficient, and more accessible model for rural communities. High quality, hospital-level care can be adapted for homes and at a much lower cost than traditional hospital care, instantly connecting rural patients to the care they need but cannot readily access, or would otherwise forgo.
Unfortunately hospitals often deliver unsafe, expensive, and inequitable care. But evidence is growing that receiving hospital-level care at home, instead of in the brick-and-mortar hospital, can ameliorate each of these issues. Globally, home hospital care has been a proven model.
Pictured Above: Dr. David Levine visiting a patient as part of the Brigham Health Home Hospital program.
PC: Brigham and Women’s Hospital
In 2020, Ariadne Labs and Dr. Levine sought rural hospital partners interested in launching their own program to participate in a randomized controlled trial, supported by the Thompson Family Foundation. Three health systems – Blessing Health in Quincy, Illinois, Appalachian Regional Healthcare, serving Kentucky and West Virginia, and Wetaskiwin Community Health Centre in Alberta, Canada – are now building, launching, and evaluating a model to provide acute care at home with hands-on support from the Ariadne Labs team.
“We see this model as the future of health care,” said Dr. Levine. “Especially in the context of COVID-19, where we’ve seen so much of health care become more virtual and more digital almost overnight, this model presents an opportunity for rural hospitals to begin to move into the digital future, optimize their capacity, and create a more sustainable model of care to better serve their patients.”
While the study will officially conclude in 2025, Dr. Levine has already published two pieces “Scoping and testing rural acute care at home: a simulation analysis” and “Rural Perceptions of Acute Care at Home: A Qualitative Analysis” in BMJ Innovations and the Journal of Rural Health, respectively, sharing optimistic findings in support of the idea of home hospital care for selective, acutely ill patients in rural settings.
Dr. Mary Frances Barthel, chief quality and safety officer at Blessing Health System, shared with The Daily Yonder, that “Past the trial stage, we hope to be able to replicate the program with staff deployed in each of our hospitals. Our goal is to have these services available from each of our facilities.”
Unfortunately, rural hospital closures are only one of several issues our country is facing when it comes to healthcare. Across the United States there are prolonged waits for behavioral health hospital beds. In Massachusetts alone, nearly 500+ people are waiting to access care on any given day. Furthermore, people experiencing homelessness face some of the most inequitable outcomes when it comes to health. But Dr. Levine and his colleagues are actively working on how to adapt the home hospital model to address these pressing needs.
For instance, Dr. Levine and Ariadne Labs are in Phase II of developing and piloting a behavioral home hospital program, attuned to the particular needs of this population (as opposed to general medicine home hospital care), with support from the Thompson Family Foundation. Phase III, to be completed in the next couple of years, will result in a randomized controlled trial, similar to the one conducted in Utah for rural home hospital health. Proof of concept for this adaptation could result in behavioral home hospital care taking root across health systems.
This year, Dr. Levine and his team are also embarking on modeling home hospital care for people experiencing homelessness. With the right housing partner onboard, Dr. Levine and his team believe they can adapt home hospital health to meet the needs of people in transitional housing, or those in need of housing
Pictured Above: Patient Bill Terry (left) gets treated at home by Dr. David Levine as part of the Brigham Health Home Hospital program.
PC: Brigham and Women’s Hospital
Whatever the circumstance, hospital care that is centered on a patient’s home holds enormous potential. Through these programs, patients receive safer, more cost effective, and comfortable care than what they would receive as an inpatient in a hospital; it has also been demonstrated that this care can be provided by a smaller and more nimble team as compared to inpatient care. Importantly, Dr. Levine and his team have not seen any glaring racial or economic disparity in who receives home hospital care, or patient outcomes. Across the board, patients with Medicaid, those dually enrolled (on Medicaid and Medicare), people with disabilities, and Black and Latinx people experience far less disparities with home hospital care than they would in a traditional emergency room or general floor of the hospital.
Home hospital care is about getting the right care to the right patient in the right place. For these reasons, it’s a promising and innovative tool for making acute healthcare more accessible and equitable for some of our most vulnerable populations.
- Ariadne Labs Home Hospital – resources, news, events, and more information on Dr. Levine and colleagues’ home hospital work
- Hospital at Home Users Group – dynamic collaborative of Hospital at Home programs around the United States and Canada. We are sharing resources and best practices, working together to expand the reach of our programs, and developing the program and policy standards to inform regulatory and reimbursement policies necessary to spread this hopeful model broadly throughout North America.
- Moving Health Home – a coalition made up of stakeholders working to change federal and state policy to enable the home to be a clinical site of care.
- American Hospital Association’s Hospital-at-Home – a growing repository of resources on hospital-at-home, including case studies and podcast.
We are thrilled to warmly welcome three new grant partners to the Rx network: The Democracy and Power Innovation Fund, In Our Own Voice: National Black Women’s Reproductive Justice Agenda, and We Got Us. These organizations join our growing collective of partners who are working collaboratively to promote health justice, healing and wellness in communities throughout the United States.
- The Democracy and Power Innovation (DPI) Fund is a partnership between state-based organizing groups, social science researchers, and aligned funders in support of learning and innovative programs that explore the connections between organizing, civic engagement, and building progressive power, with a focus on work in and led by communities of color. The DPI Fund is hosted and managed by the Rockefeller Family Fund.
- In Our Own Voice: National Black Women’s Reproductive Justice Agenda is a national-state partnership focused on lifting up the voices of Black women leaders at the national and regional levels in our fight to secure Reproductive Justice for all women, girls, and gender-expansive individuals. Together, we deliver proactive advocacy and policy solutions to address issues at the intersections of race, gender, class, sexual orientation and gender identity within the situational impacts of economics, politics and culture that make up the lived experience of Black women in the United States.
- We Got Us is a Boston-based student-led (high school, college, and graduate level) grassroots coalition committed to combating racism in our communities through increasing access to equitable healthcare, community-centered health education, and direct healing.
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