Medical Treatment at Home
An innovative program being run by the Mount Sinai Health System has shown that certain acute-care patients who choose to be treated at home rather than in a hospital are not only more satisfied with their care but also have lower medical costs and fewer medical complications.
These findings come amid the halfway point of a three-year plan that was launched by Mount Sinai in November 2014 after receiving a $9.6 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services (CMS) to create a unique “hospital at home” program.
Known as the Mobile Acute Care Team (MACT), the program illustrates Mount Sinai’s commitment to being on the cutting edge of the way medicine will be practiced and creating an innovative health care system for the future, one that emphasizes outpatient, ambulatory, and home-based care with remote monitoring capabilities. The award further highlights Mount Sinai’s role as a pioneer in developing a new clinical and financial reimbursement model for patients with acute illnesses.
To date, Mount Sinai has successfully provided hospital-level care to 236 Medicare patients in their homes, treating cases of asthma, congestive heart failure, chronic obstructive pulmonary disease, cellulitis, community-acquired pneumonia, dehydration, diabetes, deep venous thrombophlebitis, and urinary tract infection.
Health care is provided through a joint collaboration between physicians mostly from the Mount Sinai Visiting Doctors Program and community-based service providers. Patients receive daily visits from a doctor or nurse practitioner, and have equipment, therapy, and other services provided in their homes. They also receive on-call service 24 hours a day, seven days a week.
Patients participating in MACT are required to remain in their homes just as they would stay in the hospital until their treatments are completed. A social worker coordinates a care plan for patients once they are “discharged” from the program, at which time a full report is sent to the patient’s primary care physician. “Additionally, we continue to monitor patients for 30 days after discharge and will attend to any urgent medical issues that they may have,” says Linda V. DeCherrie, MD, the clinical director of MACT.
According to preliminary data compiled by the MACT program, the average length of stay for at-home treatment was 3.6 days vs. 5.1 days for an inpatient hospital stay for the same condition. In addition, Emergency Department visits and hospital readmissions after 30 days were lower for patients treated at home.
“We have demonstrated that we can deliver true acute care at home,” says Niyum Gandhi, Executive Vice President and Chief Population Health Officer at the Mount Sinai Health System. Mr. Gandhi says Mount Sinai’s hospital at home program is likely to become an increasingly desirable choice for patients in downtown Manhattan.
Digital Medicine on a Smartphone
The Icahn School of Medicine at Mount Sinai, an innovator and early adopter of digital medicine, is currently running one of the largest international clinical studies of asthma using the Apple iPhone. The Asthma Health app study tracks symptom patterns in individuals and potential triggers for their flare-ups. After downloading the app from the Apple Store, participants are able to monitor themselves and receive information that promotes positive behavioral change and reinforces adherence to treatment plans in accordance with current asthma guidelines. Since its initial U.S. rollout in March 2015, more than 9,600 research participants have enrolled in the study. This year, the study was expanded to patients in the United Kingdom and Ireland. “For the first time, we can stay with our patients 24/7 and push reminders and notifications to them,” says Yvonne Chan, MD, PhD, Director of Digital Health and Personalized Medicine at the Icahn School of Medicine at Mount Sinai. “Through technology, we can build a deeper, richer profile of each patient. We’ve demonstrated the success of electronic recruitment, consent, and remote collection of study data, all accomplished without direct, in-person contact with study investigators.” To learn more, visit: http://apps.icahn.mssm.edu/asthma.