Improving patient satisfaction, outcomes with acute care at home

Marc Zarefsky , Contributing News Writer

When infectious diseases physician Stephen Parodi, MD, pictures doctors from a century ago, he sees doctors who carried a black medical bag and routinely made house calls to care for their patients.

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Thanks to technology advances, he believes that level of care is the wave of the future—though perhaps without the black bag.

Dr. Parodi is executive vice president of external affairs, communications and brand for The Permanente Federation. He also is the associate executive director of The Permanente Medical Group, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

In 2020, Kaiser Permanente launched acute-care-at-home programs in Oregon and California, allowing patients to receive hospital-level care in the comfort of their homes.

"At its core, we're providing advanced care services in the home, so hospital-level services," Dr. Parodi said. "A patient that you would otherwise admit on a medical surgical floor in a brick-and-mortar hospital is now being taken care of in the home."

Dr. Parodi talked about how the programs have evolved and why patients and physicians like the innovative offering in a recent episode of “AMA Update.”

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When Kaiser Permanente launched its acute-care-at-home programs, it was in the early months of the COVID-19 pandemic. Now, three years later, the group is faced with full hospitals thanks in large part to deferred care, delayed care and an aging population, Dr. Parodi said.

The at-home program is a way to provide relief to the group's hospitals while giving patients more personalized care. The logistics to coordinate that type of care are immense, said Dr. Parodi, who serves on the AMA Integrated Physician Practice Section.

"You need a virtual hub that has a traditional hospital team—a doctor, a nurse, a social worker, program coordinator [and] discharge planner," he said. "And then in the field, you need services such as community paramedics, nurses, physician assistants," as well as physical therapy, occupational therapy, speech therapy and durable medical equipment.

In addition, there is a remote-monitoring component that needs to be established so that a patient's vital signs can be tracked and so the patient can contact their care team. 

"You just can't underestimate the amount of coordination that requires," said Dr. Parodi. This spring, he shared five lessons from building an acute-care-at-home program.

Learn more with the AMA Remote Patient Monitoring Implementation Playbook.

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To date, 2,600 patients have been enrolled in the acute-care-at-home program, and "the satisfaction for this has been gangbusters," Dr. Parodi said.

“People like getting this care in the home. It's more patient-centered, person-centered,” he added.

Patients appreciate the program because it means they can get care at home rather than in a hospital. Physicians, meanwhile, appreciate being able to understand the social determinants of health that can be contributing factors to the condition that led a patient to need care in the first place.

"Physicians in the program are extremely satisfied," Dr. Parodi said. "In fact, many of the hospitalists that are participating see it as an additional opportunity to exercise their skills in a new way, and doing it in a virtual way."

Another factor: “Our hospitals are full. And this is post-pandemic. We have a lot of patients coming in with a lot of advanced conditions that are related to deferred and delayed care. But I think also it's related to the aging population.”

Dr. Parodi said that readmission rates for patients who receive at-home care varies between 8% and 13%, depending on the month, and only 1-2% of patients have required care that escalated to a hospital or emergency department.

Dr. Parodi hopes to continue enrolling more people in the program and watching it continue to evolve, giving patients and physicians a new model of care that is innovative and impactful.

There will always " be a need for people to be in brick-and-mortar facilities—people that need intensive care, people that need complex surgery," he said. "But I think what we're seeing here is the ability to scale in ways that are new, ways that are person-centered, ways that we can reach people into their homes."

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.