• Care in Place: Bringing Care Back to the Future

    Steven Strongwater and Eliza Shulman Mar 14, 2017

    Steven StrongwaterLast winter, an 83-year-old man experienced weakness over the course of a few days after having been in and out of the hospital several times during the previous year. He had trouble getting out of bed, but the patient’s wife—also his caregiver—was hesitant to put him through another emergency department (ED) evaluation.

    This problem is familiar to elderly patients who may be very ill, frail, or homebound and have trouble getting to their doctor’s office. In 2015, our organization, Atrius Health, had launched an innovation center to help drive new solutions to this sort of recurring issue.

    After meeting with patients—both in our offices and in their homes—to learn how we could better serve them, our innovation team developed the Care in Place program. Each week through the program, a staff of five from Atrius Health and our home health subsidiary, VNA Care, conducts an average of 20 home visits to patients and their families.

    Pippa ShulmanFor the elderly gentleman mentioned above, Care in Place sent a registered nurse from VNA Care. To the delight of the patient and his wife, the nurse conducted an assessment using a mobile X-ray and consulted with an Atrius Health nurse practitioner to determine the appropriate treatment.

    Home Over Hospital

    Described by some as a “back-to-the-future approach” to health care, Care in Place represents our philosophy of providing coordinated care that keeps patients out of the hospital and in the comfort of their own homes. Now implemented across our entire practice, the program ensures that when we receive a call during the day from someone who is older than 65 and unable to come to the office, an on-call triage nurse determines whether the patient requires an ED visit or can be seen at home by a VNA Care nurse.

    Through our collaboration with VNA Care, the visiting nurse has access to the patient’s medical records and can work with a member of the patient’s primary care team for support with clinical decision making. After giving treatment, the visiting nurse develops a care plan, schedules a follow-up visit, and shares that information with the patient’s primary care physician.

    We invest in creating programs like Care in Place because it is the right thing to do for our patients. This program has the added benefit of being cost-effective. In fact, Care in Place generated more than $800,000 in cost savings in its first 10 months.

    More importantly, we have kept nearly 40 percent of program participants out of the ED, saving them the long wait and stress of an ED visit and potentially an unnecessary hospital stay.

    As we continue to expand this program to better serve our patients in their homes, we are awaiting final state regulations that will allow us to enlist paramedics—who are authorized to carry and administer medications on-site—to work alongside our team of nurses and nurse practitioners to provide coverage 24/7 (incorporating paramedics would require planning for adequate medical oversight).

    Part of a Bigger Picture

    As more health systems consider initiatives that bring urgent care to patient’s homes, our most important piece of advice is that this work cannot be done in a vacuum. Instead, it must be part of a larger dialogue with patients and providers aimed at solving the everyday problems people face in accessing care.

    By getting to know their patients, collaborating organizations can create programs like Care in Place that serve patients better. Organizations working together in this capacity must be able to seamlessly share information from electronic health records to ensure that they are providing the right care and that the patient’s primary care team is an active part of the process.

    Hearing the voice of our patients is the best way to start.

    Steven Strongwater, MD, is president and CEO, Atrius Health, Newton, Mass.

    Eliza (Pippa) Shulman, DO, MPH, is senior chief innovation engineer, Atrius Health Innovation Center, Needham, Mass.

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