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Hospital-Level Care From The Comfort Of Home
The COVID-19 pandemic caused hospitals to rethink how and where they offered care to their patients. What if you could receive the same high-quality care you’d expect from a stay at the hospital in your own home? VCU Health specialist, Dr. Julia Breton, is here today to tell us more about their Home Hospital services - the first hospital-at-home program in central Virginia.
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Learn more about Julia Breton, MD
Julia Breton, MD
Julia Breton, MD is a Physician with specialized training in the care of older adults.Learn more about Julia Breton, MD
Transcription:
Hospital-Level Care From The Comfort Of Home
Cheryl Martin (Host): The COVID-19 pandemic caused many hospitals to rethink how and where they offer care to their patients. What if you could receive the same high-quality care you expect from a stay at the hospital in your own home?
VCU Health Specialist, Dr. Julia Breton, is here to tell us about their new Home Hospital Services, the first hospital-at-home program in Central Virginia. This is Healthy with VCU Health. I'm Cheryl Martin. Dr. Breton, before we discuss home hospital, please tell us something about your background.
Dr. Julia Breton: Sure. So, I am a geriatrician, which is a doctor who specializes in the care of older adults. I did my undergraduate at the University of Virginia and my medical school actually here at VCU and went up to Boston to do the rest of my medical training, did my residency at Tufts and my fellowship in geriatrics at Harvard. And then, I did house calls in the Boston area for a while with a team of nurses and social workers, providing not only primary care, but also urgent care and end-of-life care. My career's really been dedicated to trying to deliver as much care as possible in the home. And so when we moved back to Richmond, my hometown, there was a really wonderful program developing here, Remote Patient Monitoring, to try to serve VCU patients at home after they've been discharged from the hospital. And then more recently, I've had the privilege and the pleasure of being a co-medical director for our brand-new Home Hospital Program.
Cheryl Martin (Host): So, you are the ideal person to be a part of this program and to oversee it. What is a home hospital?
Dr. Julia Breton: It is exactly what it sounds like. It's hospital level acute care provided in the home setting instead of in the brick and mortar. This type of care has actually been practiced for decades around the world, especially in the UK and Australia and a few select academic institutions in the United States like Hopkins and Mount Sinai. But one of the silver linings, you could say, of the COVID pandemic was that it forced health systems and payers to really think outside the box about how we deliver care and then how we support that delivery of care. With advancements in technology and mobile services, the CMS, that's the Centers for Medicare and Medicaid, created a waiver that health systems could apply for, to be allowed to provide this type of acute care in the home setting.
Cheryl Martin (Host): So, how does it work?
Dr. Julia Breton: There's a pretty extensive screening process. We want to make sure that clinically we're able to meet all the medical needs in the home setting and also a social screening to make sure that the home is a safe place to provide care. But it otherwise works just like a hospital stay in the brick and mortar where you have a doctor overseeing your care.
If you're eligible for the program and you decide to enroll, one of our VCU Health hospitalists will meet you in the hospital and do physical exam, and get to know you. Then, when you transfer home for the rest of your hospital care, the doctor will see you virtually every day. And you have nurses and medics that do visits into the home to provide care. That’s at least twice a day that you have a team member going into your home to provide care. And then, there's a 24/7 command center, that's what we call our 24/7 nurse support center. And these are our own VCU Health nurses who are available to address any concerns. They can also virtually help with medications, checking vital signs. We can provide IV treatments in the home, so that could be IV fluids, IV antibiotics or other IV medications. We can provide oxygen in the home, and whatever equipment you might need, so for example, like a bedside commode or a walker. And of course, the medications that you need for your hospital stay are also delivered to the home. We can do labs in the home. We can do some imaging in the home. And so, you're able to get that really high-quality inpatient care, but from the comfort of your own home.
Cheryl Martin (Host): It sounds like it's high-quality care. Are there any other benefits of having a hospital-at-home service for patients? What kind of feedback have you gotten from patients who said they would prefer this kind of hospital level care at home?
Dr. Julia Breton: Well, nationally, and now we're seeing with our very own program, patient and caregiver satisfaction rates are just off the charts. People are really happy to have this patient-centered care. It takes so much stress off the patient and caregivers to have their loved ones at home. We actually had a patient cry the other day when she found out that she qualified for the program because she was just so happy to be able to go back home.
Other great benefits of this program are that length of stay tends to be shorter. So, that's how long your hospital stay is. And a lot of this comes from people are able to eat, sleep and rehab better from the comfort of their home. And so, they tend to recover a little bit faster, so their hospital stay is shorter. And then, a lot of patients are able to avoid needing to go to a skilled nursing facility for rehab therapy after their hospitalization because they were actually able to get back their strength a little bit faster from the comfort of their home than from the brick and mortar. Fall rates are less. Infection rates are less. Morbidity and mortality rates are lower. And readmission rates are lower, Readmission is when a patient ends up right back in the hospital after they've just completed a hospital stay. And of course, this is something that we don't want for our patients and our patients certainly don't want for themselves either. But because our team is in the home really getting to know the patient and what kind of supports they need at home to be successful after they've discharged, we're able to avoid a lot of those readmissions.
Cheryl Martin (Host): What would you say makes home hospital services at VCU Health unique?
Dr. Julia Breton: Well, we are actually the first health system in central Virginia to offer this type of program. So, that in and of itself is very exciting. We're no stranger to delivering care into the home. We've actually had a home-based primary care program for over four decades. And we've had leaders who have just been open to innovation and developing new programs and ways to support patients in the home. We have a transitional care program to support patients in the home after they've left the hospital, remote patient monitoring, which I mentioned earlier. We also have VCU Home Health and Home Hospice. So, it's just really exciting to be able to offer acute, inpatient hospital care in the home, then transitional care for someone, you know, after a hospitalization and then, finally also being able to offer primary care into the home, that whole continuum of care into the home setting.
Cheryl Martin (Host): Now, you talked a little bit about this earlier, but specifically what kinds of patients would be ideal or eligible for VCU Health's Home Hospital Services, if they have what kinds of conditions would you say?
Dr. Julia Breton: So first of all, for patients to transfer into the program, they have to have come through VCU Medical Center in the sense that they have to have come into our emergency department or already be a patient in the hospital and be deemed stable enough to transfer the remainder of their care into the home. Some examples of conditions that can be treated well in the home are a lot of infections, like pneumonia, cellulitis, a complicated UTI that might need IV antibiotics, congestive heart failure, or CHF, or a COPD exacerbation. Even for certain COVID therapies that can only be provided in the hospital, we can provide those through home hospital.
Cheryl Martin (Host): How long typically does home hospital care last?
Dr. Julia Breton: So, it lasts the length of your hospital stay. So, when your care team, your providers, know that you're ready for discharge from your hospital stay, you'll be discharged from the home hospital program. Throughout your hospital admission, we're working on plans to make sure that you have the supports you need after discharge, so making sure that you've got a follow up plan with a primary care provider, that you have your medications ready at discharge, that you have whatever supplies you need, that you have home health, if that's something that you need at discharge.
Cheryl Martin (Host): Would patients find that at the end of their time that this provides a lower cost for them than hospital stay?
Dr. Julia Breton: It does tend to provide a lower cost. So, that's an additional benefit certainly for the patient.
Cheryl Martin (Host): Well, Dr. Julia Breton, thank you for coming on to discuss what is a great option for your patient. Home Hospital Care is another innovative program from VCU Health, providing you access to quality hospital level care in the comfort of your home. It gives patients and their families an important choice about how you want to be cared for. When it comes to choosing your healthcare, VCU Health has you covered. For more information, visit vcuhealth.org/home-hospital. That's vcuhealth.org/home-hospital or call 804-628-HOME. That's 804-628-HOME.
If you found this podcast helpful, please share it on your social channels. Explore our entire podcast library at vcuhealth.org/podcast for more health topics of interest to you. This is Healthy with VCU Health. Thanks for listening.
Hospital-Level Care From The Comfort Of Home
Cheryl Martin (Host): The COVID-19 pandemic caused many hospitals to rethink how and where they offer care to their patients. What if you could receive the same high-quality care you expect from a stay at the hospital in your own home?
VCU Health Specialist, Dr. Julia Breton, is here to tell us about their new Home Hospital Services, the first hospital-at-home program in Central Virginia. This is Healthy with VCU Health. I'm Cheryl Martin. Dr. Breton, before we discuss home hospital, please tell us something about your background.
Dr. Julia Breton: Sure. So, I am a geriatrician, which is a doctor who specializes in the care of older adults. I did my undergraduate at the University of Virginia and my medical school actually here at VCU and went up to Boston to do the rest of my medical training, did my residency at Tufts and my fellowship in geriatrics at Harvard. And then, I did house calls in the Boston area for a while with a team of nurses and social workers, providing not only primary care, but also urgent care and end-of-life care. My career's really been dedicated to trying to deliver as much care as possible in the home. And so when we moved back to Richmond, my hometown, there was a really wonderful program developing here, Remote Patient Monitoring, to try to serve VCU patients at home after they've been discharged from the hospital. And then more recently, I've had the privilege and the pleasure of being a co-medical director for our brand-new Home Hospital Program.
Cheryl Martin (Host): So, you are the ideal person to be a part of this program and to oversee it. What is a home hospital?
Dr. Julia Breton: It is exactly what it sounds like. It's hospital level acute care provided in the home setting instead of in the brick and mortar. This type of care has actually been practiced for decades around the world, especially in the UK and Australia and a few select academic institutions in the United States like Hopkins and Mount Sinai. But one of the silver linings, you could say, of the COVID pandemic was that it forced health systems and payers to really think outside the box about how we deliver care and then how we support that delivery of care. With advancements in technology and mobile services, the CMS, that's the Centers for Medicare and Medicaid, created a waiver that health systems could apply for, to be allowed to provide this type of acute care in the home setting.
Cheryl Martin (Host): So, how does it work?
Dr. Julia Breton: There's a pretty extensive screening process. We want to make sure that clinically we're able to meet all the medical needs in the home setting and also a social screening to make sure that the home is a safe place to provide care. But it otherwise works just like a hospital stay in the brick and mortar where you have a doctor overseeing your care.
If you're eligible for the program and you decide to enroll, one of our VCU Health hospitalists will meet you in the hospital and do physical exam, and get to know you. Then, when you transfer home for the rest of your hospital care, the doctor will see you virtually every day. And you have nurses and medics that do visits into the home to provide care. That’s at least twice a day that you have a team member going into your home to provide care. And then, there's a 24/7 command center, that's what we call our 24/7 nurse support center. And these are our own VCU Health nurses who are available to address any concerns. They can also virtually help with medications, checking vital signs. We can provide IV treatments in the home, so that could be IV fluids, IV antibiotics or other IV medications. We can provide oxygen in the home, and whatever equipment you might need, so for example, like a bedside commode or a walker. And of course, the medications that you need for your hospital stay are also delivered to the home. We can do labs in the home. We can do some imaging in the home. And so, you're able to get that really high-quality inpatient care, but from the comfort of your own home.
Cheryl Martin (Host): It sounds like it's high-quality care. Are there any other benefits of having a hospital-at-home service for patients? What kind of feedback have you gotten from patients who said they would prefer this kind of hospital level care at home?
Dr. Julia Breton: Well, nationally, and now we're seeing with our very own program, patient and caregiver satisfaction rates are just off the charts. People are really happy to have this patient-centered care. It takes so much stress off the patient and caregivers to have their loved ones at home. We actually had a patient cry the other day when she found out that she qualified for the program because she was just so happy to be able to go back home.
Other great benefits of this program are that length of stay tends to be shorter. So, that's how long your hospital stay is. And a lot of this comes from people are able to eat, sleep and rehab better from the comfort of their home. And so, they tend to recover a little bit faster, so their hospital stay is shorter. And then, a lot of patients are able to avoid needing to go to a skilled nursing facility for rehab therapy after their hospitalization because they were actually able to get back their strength a little bit faster from the comfort of their home than from the brick and mortar. Fall rates are less. Infection rates are less. Morbidity and mortality rates are lower. And readmission rates are lower, Readmission is when a patient ends up right back in the hospital after they've just completed a hospital stay. And of course, this is something that we don't want for our patients and our patients certainly don't want for themselves either. But because our team is in the home really getting to know the patient and what kind of supports they need at home to be successful after they've discharged, we're able to avoid a lot of those readmissions.
Cheryl Martin (Host): What would you say makes home hospital services at VCU Health unique?
Dr. Julia Breton: Well, we are actually the first health system in central Virginia to offer this type of program. So, that in and of itself is very exciting. We're no stranger to delivering care into the home. We've actually had a home-based primary care program for over four decades. And we've had leaders who have just been open to innovation and developing new programs and ways to support patients in the home. We have a transitional care program to support patients in the home after they've left the hospital, remote patient monitoring, which I mentioned earlier. We also have VCU Home Health and Home Hospice. So, it's just really exciting to be able to offer acute, inpatient hospital care in the home, then transitional care for someone, you know, after a hospitalization and then, finally also being able to offer primary care into the home, that whole continuum of care into the home setting.
Cheryl Martin (Host): Now, you talked a little bit about this earlier, but specifically what kinds of patients would be ideal or eligible for VCU Health's Home Hospital Services, if they have what kinds of conditions would you say?
Dr. Julia Breton: So first of all, for patients to transfer into the program, they have to have come through VCU Medical Center in the sense that they have to have come into our emergency department or already be a patient in the hospital and be deemed stable enough to transfer the remainder of their care into the home. Some examples of conditions that can be treated well in the home are a lot of infections, like pneumonia, cellulitis, a complicated UTI that might need IV antibiotics, congestive heart failure, or CHF, or a COPD exacerbation. Even for certain COVID therapies that can only be provided in the hospital, we can provide those through home hospital.
Cheryl Martin (Host): How long typically does home hospital care last?
Dr. Julia Breton: So, it lasts the length of your hospital stay. So, when your care team, your providers, know that you're ready for discharge from your hospital stay, you'll be discharged from the home hospital program. Throughout your hospital admission, we're working on plans to make sure that you have the supports you need after discharge, so making sure that you've got a follow up plan with a primary care provider, that you have your medications ready at discharge, that you have whatever supplies you need, that you have home health, if that's something that you need at discharge.
Cheryl Martin (Host): Would patients find that at the end of their time that this provides a lower cost for them than hospital stay?
Dr. Julia Breton: It does tend to provide a lower cost. So, that's an additional benefit certainly for the patient.
Cheryl Martin (Host): Well, Dr. Julia Breton, thank you for coming on to discuss what is a great option for your patient. Home Hospital Care is another innovative program from VCU Health, providing you access to quality hospital level care in the comfort of your home. It gives patients and their families an important choice about how you want to be cared for. When it comes to choosing your healthcare, VCU Health has you covered. For more information, visit vcuhealth.org/home-hospital. That's vcuhealth.org/home-hospital or call 804-628-HOME. That's 804-628-HOME.
If you found this podcast helpful, please share it on your social channels. Explore our entire podcast library at vcuhealth.org/podcast for more health topics of interest to you. This is Healthy with VCU Health. Thanks for listening.