Role of Hospital at Home in Population Health
BayCare wants the best care for you and your family. We know that scheduling regular doctors’ appointments or having to go to urgent care or the hospital can be difficult. For patients who need regular monitoring, BayCare offers @Home, a program allowing patient vitals to be checked from the convenience of their own home.
Featured Speaker:
Learn more about Dr. Cawley
Jackie Cawley, DO, MBA
Dr. Cawley is an innovative executive with more than 20 years of leadership experience in a variety of academic and health care settings. During her various roles at MaineHealth, she has been responsible for leading strategic planning, development, budgeting, clinical compliance, population health initiatives, management and operations of many departments and programs.Learn more about Dr. Cawley
Transcription:
Role of Hospital at Home in Population Health
Caitlin Whyte: We at BayCare know that scheduling regular doctor's appointments or having to go to urgent care or the hospital to monitor vitals can be difficult. So, we created a service called BayCare at home to help. Joining us to talk about this service is the Vice President of Population Health and Chief Medical Officer of Ambulatory Care, Jackie Cawley.
This is Pop Health Chat with BayCare PHSO. I'm your host, Caitlin Whyte. So Jackie, kick us off here today, just what is BayCare At Home?
Jackie Cawley: Well, thank you for asking that question. BayCare At Home is a set of services services that we bring to patients in the safety and comfort of their homes instead of having them have to stay in the hospital. We get referrals from either community physicians, from physicians in the emergency department or sometimes the hospitalists in our hospitals to either help transition patients out a little bit early, then otherwise they may have had to stay in the hospital and be safely cared for at home. Or instead of being admitted to the hospital, be admitted to a hospital-like set of services in their own home.
And these set of services include remote patient monitoring with virtual nursing care that is accessible to them, you know, throughout the whole day. We have virtual providers that are available 24 hours a day, and we also have skilled nurses that go into the home at least twice a day. And we can deliver just about anything that you would need in the hospital, including having your laboratory, your labs done on a daily basis, bringing imaging studies to you and also IV therapy, oxygen, physical therapy, anything that you might need in order to care for your condition in a safe place at home. And it's been a great experience for patients. We've cared for about 300 patients in this way over the last two years.
Caitlin Whyte: Well, this sounds like a wonderful option, Jackie. And you know, with all these virtual and remote ways of contact that we're getting into these days, it involves a lot of technology. And I know technology isn't the easiest to get a grasp on for everyone. So, tell us a bit about the devices involved with BayCare At Home and how people can get acquainted with those.
Jackie Cawley: Oh, of course. I'd love to. So with the technology, the first thing we do is when we do get a referral for patients for the program, we do a review to make sure that the patient, one, can be safe at home. And the second is that they can utilize the technology that we use in the home. So, the technology that we generally use will either be a device that someone has at home already, a tablet, a computer, a cell phone. If they don't have that or they need a little bit of extra help, we have specialized tablets that we provide to the patients. Within a couple of hours, we can actually get it to the home and help the patient install that. And then, we also provide them what we call peripherals. These are devices that connect to the tablet or download information into the tablet to help people with having their weight uploaded, their blood pressure, other vital signs like their temperature, even their oxygen level can be downloaded into the tablet. And then, that information gets sent along to our virtual nursing staff who are there to monitor those patients on an ongoing basis.
In addition, there's questions that come to the patient based on their condition every single day, And the questions will ask them how they're feeling, if they're having any worsening of their symptoms, how they're breathing, et cetera. And if there's anything that is out of range or seems to be a change in their trend, then that alerts nurses to reach out actually to the patient and talk to them either by phone or through the tablet and have a virtual conversation with them.
Caitlin Whyte: Well, that actually leads me into my next question with monitoring these vitals from a distance. What happens if a patient's readings, like you said, produces an alert in that system? It sounds like there's a followup call. And then, I guess, what happens from there with the patient being at home?
Jackie Cawley: The nurse will actually do an assessment with the patient. If there's some concerns, they'll escalate it up to the provider, so the provider can join them virtually as well. If we need to, we'll deploy a nurse into the field and go to the patient's home directly. And sometimes, we will talk to the patient and actually facilitate the EMS or the emergency transport folks to go to the home and stay with the patient online with them until the emergency services arrive, because occasionally they need to have their care escalated to a higher level. And we want to be able to facilitate that in a very safe. And it's funny because sometimes the patients will fight back, they don't want to go. we're like, "No, your doctor really thinks this is important. We think it's important too." And then, they'll go to the hospital to get admitted to the intensive care unit or something, and they'll call us back a few days later and they'll say, you know, "You saved my life." So, it's very rewarding for the team either being able to help, you know, either deploy more oxygen into the field if they need it. Our COVID patients initially, they were so anxious. So, just being able to have the nurse work with them, you know, adjust their oxygen, you know, get them connected with their doctor, and have that conversation and get their needs met, really helped to reduce a lot of anxiety.
Caitlin Whyte: Well, this does just sound like an incredibly intuitive service for patients who just want to be at home. Now, I understand that patient's families can also log in and participate in these meetings and appointments virtually as well. So, why would something like that be beneficial?
Jackie Cawley: That's beneficial because it includes the family or the other caregivers and helps to make sure that they understand what the needs of the patient are as well. You know, when you're sick and you're not feeling well, it's really hard to absorb all the information that you might be getting from your care team. So, having the family members involved just allows other people to know what they should be looking out for as far as, you know, worsening symptoms, what the medication regimens are, and just to know that we're a point of contact. If they need anything, we're there for them.
Caitlin Whyte: Absolutely. Well, Jackie, how can people learn more and find out if they're eligible to enroll in this program?
Jackie Cawley: Well, our providers are available 24/7. So if a community physician has a question or thinks they have a patient that would be a good referral or they just want to learn more about the program, they just need to give us a call at 727-561-2437. And we do have those providers, you know, 24/7 available for conversations. And we also can receive information through a fax and we have a website as well. And so if anyone's interested, just reaching out to BayCare Physicians Partners and our Population Health Service Organization, our care managers and nurses or others can, you know, share that information with our physicians and other providers in the community and see if this is a program that'll work for you and your patients.
Caitlin Whyte: Beautiful. Well, Jackie, is there anything about BayCare At Home that we didn't touch on today?
Jackie Cawley: I think just, you know, again, emphasizing that our job with BayCare Physician Partners and BayCare as a system is really focused on our patients and their families. And we want to make sure that the right care is provided in the right setting, wherever possible. And the pandemic taught us a lot. We know that we can provide patients really safe care at home in the comfort of their homes, and that can really help to facilitate their recovery. So, just keeping BayCare Home Care and BayCare homebased services in mind.
Caitlin Whyte: Well, thank you so much for your time and care today, Jackie. We just love hearing all about the innovations happening at BayCare. You can find out more about this service at baycare.org, This has been Pop Health Chat. I'm Caitlin Whyte. Stay well.
Role of Hospital at Home in Population Health
Caitlin Whyte: We at BayCare know that scheduling regular doctor's appointments or having to go to urgent care or the hospital to monitor vitals can be difficult. So, we created a service called BayCare at home to help. Joining us to talk about this service is the Vice President of Population Health and Chief Medical Officer of Ambulatory Care, Jackie Cawley.
This is Pop Health Chat with BayCare PHSO. I'm your host, Caitlin Whyte. So Jackie, kick us off here today, just what is BayCare At Home?
Jackie Cawley: Well, thank you for asking that question. BayCare At Home is a set of services services that we bring to patients in the safety and comfort of their homes instead of having them have to stay in the hospital. We get referrals from either community physicians, from physicians in the emergency department or sometimes the hospitalists in our hospitals to either help transition patients out a little bit early, then otherwise they may have had to stay in the hospital and be safely cared for at home. Or instead of being admitted to the hospital, be admitted to a hospital-like set of services in their own home.
And these set of services include remote patient monitoring with virtual nursing care that is accessible to them, you know, throughout the whole day. We have virtual providers that are available 24 hours a day, and we also have skilled nurses that go into the home at least twice a day. And we can deliver just about anything that you would need in the hospital, including having your laboratory, your labs done on a daily basis, bringing imaging studies to you and also IV therapy, oxygen, physical therapy, anything that you might need in order to care for your condition in a safe place at home. And it's been a great experience for patients. We've cared for about 300 patients in this way over the last two years.
Caitlin Whyte: Well, this sounds like a wonderful option, Jackie. And you know, with all these virtual and remote ways of contact that we're getting into these days, it involves a lot of technology. And I know technology isn't the easiest to get a grasp on for everyone. So, tell us a bit about the devices involved with BayCare At Home and how people can get acquainted with those.
Jackie Cawley: Oh, of course. I'd love to. So with the technology, the first thing we do is when we do get a referral for patients for the program, we do a review to make sure that the patient, one, can be safe at home. And the second is that they can utilize the technology that we use in the home. So, the technology that we generally use will either be a device that someone has at home already, a tablet, a computer, a cell phone. If they don't have that or they need a little bit of extra help, we have specialized tablets that we provide to the patients. Within a couple of hours, we can actually get it to the home and help the patient install that. And then, we also provide them what we call peripherals. These are devices that connect to the tablet or download information into the tablet to help people with having their weight uploaded, their blood pressure, other vital signs like their temperature, even their oxygen level can be downloaded into the tablet. And then, that information gets sent along to our virtual nursing staff who are there to monitor those patients on an ongoing basis.
In addition, there's questions that come to the patient based on their condition every single day, And the questions will ask them how they're feeling, if they're having any worsening of their symptoms, how they're breathing, et cetera. And if there's anything that is out of range or seems to be a change in their trend, then that alerts nurses to reach out actually to the patient and talk to them either by phone or through the tablet and have a virtual conversation with them.
Caitlin Whyte: Well, that actually leads me into my next question with monitoring these vitals from a distance. What happens if a patient's readings, like you said, produces an alert in that system? It sounds like there's a followup call. And then, I guess, what happens from there with the patient being at home?
Jackie Cawley: The nurse will actually do an assessment with the patient. If there's some concerns, they'll escalate it up to the provider, so the provider can join them virtually as well. If we need to, we'll deploy a nurse into the field and go to the patient's home directly. And sometimes, we will talk to the patient and actually facilitate the EMS or the emergency transport folks to go to the home and stay with the patient online with them until the emergency services arrive, because occasionally they need to have their care escalated to a higher level. And we want to be able to facilitate that in a very safe. And it's funny because sometimes the patients will fight back, they don't want to go. we're like, "No, your doctor really thinks this is important. We think it's important too." And then, they'll go to the hospital to get admitted to the intensive care unit or something, and they'll call us back a few days later and they'll say, you know, "You saved my life." So, it's very rewarding for the team either being able to help, you know, either deploy more oxygen into the field if they need it. Our COVID patients initially, they were so anxious. So, just being able to have the nurse work with them, you know, adjust their oxygen, you know, get them connected with their doctor, and have that conversation and get their needs met, really helped to reduce a lot of anxiety.
Caitlin Whyte: Well, this does just sound like an incredibly intuitive service for patients who just want to be at home. Now, I understand that patient's families can also log in and participate in these meetings and appointments virtually as well. So, why would something like that be beneficial?
Jackie Cawley: That's beneficial because it includes the family or the other caregivers and helps to make sure that they understand what the needs of the patient are as well. You know, when you're sick and you're not feeling well, it's really hard to absorb all the information that you might be getting from your care team. So, having the family members involved just allows other people to know what they should be looking out for as far as, you know, worsening symptoms, what the medication regimens are, and just to know that we're a point of contact. If they need anything, we're there for them.
Caitlin Whyte: Absolutely. Well, Jackie, how can people learn more and find out if they're eligible to enroll in this program?
Jackie Cawley: Well, our providers are available 24/7. So if a community physician has a question or thinks they have a patient that would be a good referral or they just want to learn more about the program, they just need to give us a call at 727-561-2437. And we do have those providers, you know, 24/7 available for conversations. And we also can receive information through a fax and we have a website as well. And so if anyone's interested, just reaching out to BayCare Physicians Partners and our Population Health Service Organization, our care managers and nurses or others can, you know, share that information with our physicians and other providers in the community and see if this is a program that'll work for you and your patients.
Caitlin Whyte: Beautiful. Well, Jackie, is there anything about BayCare At Home that we didn't touch on today?
Jackie Cawley: I think just, you know, again, emphasizing that our job with BayCare Physician Partners and BayCare as a system is really focused on our patients and their families. And we want to make sure that the right care is provided in the right setting, wherever possible. And the pandemic taught us a lot. We know that we can provide patients really safe care at home in the comfort of their homes, and that can really help to facilitate their recovery. So, just keeping BayCare Home Care and BayCare homebased services in mind.
Caitlin Whyte: Well, thank you so much for your time and care today, Jackie. We just love hearing all about the innovations happening at BayCare. You can find out more about this service at baycare.org, This has been Pop Health Chat. I'm Caitlin Whyte. Stay well.