Citations

Background: Mayo Clinic’s Care Hotel is a virtual hybrid care model which allows postoperative patients to recover in a comfortable environment after a low-risk procedure. Hospitals need to understand the key patient factors that promote acceptance of the Care Hotel if they are to benefit from this innovative care model. This study aims to identify factors that can predict whether a patient will stay at Care Hotel. Materials and methods: This retrospective chart review of 1065 patients was conducted between 23 July 2020, and 31 December 2021. Variables examined included patient age, sex, race, ethnicity, Charlson comorbidity index, distance patient travelled to hospital, length of surgery, day of the week of surgery, and surgical service. Associations of patient and surgery characteristics with the primary outcome of staying at the Care Hotel were assessed using unadjusted and multivariable logistic regression models. Results: Of the 1065 patients who met criteria for admission to the Care Hotel during the study period, 717 (67.3%) chose to stay at the Care Hotel while 328 (32.7%) choose to be admitted to the hospital. In multivariable analysis, there was a significant association between surgical service and staying at the Care Hotel (P<0.001). Specifically, there was a higher likelihood of staying at the Care Hotel for patients from Neurosurgery [odds rato (OR)=1.86, P=0.004], Otorhinolaryngology (OR=2.70, P<0.001), and General Surgery (OR=2.75, P=0.002). Additionally, there was a higher likelihood of staying at the Care Hotel with distance travelled over 110 miles [OR (per each doubling)=1.10, P=0.007]. Conclusion: When developing a post-surgical care model for patients following outpatient procedures, the referring surgical service is a primary factor to consider in order to ensure patient acceptance, along with patient distance. This study can assist other healthcare organizations considering this model, as it provides guidance on which factors are most indicative of acceptance.

In the US, at least one fall occurs in at least 28.7% of community-dwelling seniors 65 and older each year. Falls had medical costs of USD 51 billion in 2015 and are projected to reach USD 100 billion by 2030. This review aims to discuss the extent of smartphone (SP) usage in fall detection and prevention across a range of care settings. A computerized search was conducted on six electronic databases to investigate the use of remote sensing technology, wireless technology, and other related MeSH terms for detecting and preventing falls. After applying inclusion and exclusion criteria, 44 studies were included. Most of the studies targeted detecting falls, two focused on detecting and preventing falls, and one only looked at preventing falls. Accelerometers were employed in all the experiments for the detection and/or prevention of falls. The most frequent course of action following a fall event was an alarm to the guardian. Numerous studies investigated in this research used accelerometer data analysis, machine learning, and data from previous falls to devise a boundary and increase detection accuracy. SP was found to have potential as a fall detection system but is not widely implemented. Technology-based applications are being developed to protect at-risk individuals from falls, with the objective of providing more effective and efficient interventions than traditional means. Successful healthcare technology implementation requires cooperation between engineers, clinicians, and administrators.

In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes.

Abstract Background: A recent report from the AACR has found that black men (BM) men have prostate cancer (CaP) death rates that are more than 2 times those for men of any other race or ethnicity. Yet, BM are less likely to receive cutting-edge, or even standard of care treatment compared to their white counterparts. Limited access to care, transportation, patient perception and medical mistrust, as well as cost of care are major contributing factors. Meeting patients where they are and offering treatment in or closer to their homes should help reduce psychological distress and increase access to care and treatment compliance. As part of the iCCaRE for Black men Consortium, we propose a PCHC model which leverages Mayo Clinic Advanced Care at Home (ACH) program and provides a package of care to support the administration of cancer therapy and/or supportive care/symptom management to CaP patients in their homes by specialist healthcare professionals. The objectives of our pilot study are to understand patients’ choice of therapy in choosing the place of treatment and to evaluate the feasibility and impact of PCHC on clinical outcomes, as well as patient reported-outcomes (PRO) and health related quality of life (HQOL). Methodology: For Aim 1, structured questionnaires are used to assess patient preference for location of therapy, at the infusion center or in the home, as well as perceived difficulties and advantages; follow up qualitative data will be collected through semi-structured interviews to capture patients’ thoughts, feelings, attitudes, and questions towards cancer treatments being administered at home versus in a hospital setting. Aim 2 is an observational study of BM with advanced CaP who are participating in a pragmatic, practice-based randomized clinical trial to track acceptability by and impact of home administration of cancer directed or supportive therapy. Results: For Aim 1, data is used to identify themes regarding perceived advantages and concerns of PCHC and inform our understanding of the proportion of patients who are willing to receive and would benefit from this level of care at home. For Aim 2, the following outcomes are evaluated: (a) time to first ER visit and to first hospitalization; (b) HRQoL and quality-adjusted survival; (c) patient satisfaction and compliance, including home time, adherence with symptom self-reporting and compliance with treatment, level of comfort interacting with the care team by phone or tablet, ability to reach a team member for questions or concerns; (d) cost, including out of pocket cost for patients. Conclusion: Our project will provide data on patient understanding and acceptability of cancer care at home and strategies for overcoming cancer care delivery disparities and barriers of access to care for underserved communities. The expected outcome of our project is that PCHC intervention will positively impact CaP treatment, patients’ access and experience with healthcare by developing a new concept of closer-to home cancer care delivery that will reach more patients in underserved communities. Citation Format: Roxana Dronca, Rohit Rao, Michael Maniaci, Folakemi Odedina, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Manisha Salinas, Sha’Reff Rashad, Arnold Merriweather, John McCall, Ebenezer Erefah, Ayinde Yahaya. Feasibility of patient-centered home care (PCHC) to reduce disparities in Black men (BM) with advanced prostate cancer (CaP): An iCCaRE Consortium for prostate cancer in Black men project [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B046.

Abstract High healthcare utilizers are often chronically ill patients who require aggressive hospital and outpatient care. We describe a patient with septic shock who was stabilized in the intensive care unit, then transitioned to a virtual hybrid hospital‐at‐home to complete both inpatient care as well as outpatient wound and rehabilitation therapy.

In 2020, Mayo Clinic established an Advanced Care at Home (ACH) program. ACH is a virtual hybrid hospital-at-home (HaH) program that combines telemedicine with in-home care services by utilizing a state that is software-driven, vendor-mediate medical supply chain. The program initially focused on acute medical diagnosis but has expanded to oversee surgical and postsurgical patients with continued inpatient needs. Here, we report the first case of a small bowel obstruction (SBO) managed under a HaH program. A 52-year-old lady presented to the emergency department with symptoms suggestive of mechanical SBO. The diagnosis was confirmed with an abdominopelvic computed tomography (CT) scan, and the patient was admitted to the hospital. Based on the patient’s presentation and laboratory results, the care team proceeded with conservative treatment including nasogastric tube (NG) placement and suctioning, intravenous (IV) fluid replacement, and daily laboratory studies. She spent the first hospital day in the physical hospital ward so that the surgical team could ensure stability clinically and no urgent need for surgical intervention. On hospital day two, she was transferred home with ACH where the NG suctioning and IV replacement therapy could continue, while the medical team conducted daily virtual visits to ensure continued improvement. Additionally, a paramedic and a nurse performed an in-person, head-to-toe assessment and administered medications to the patient twice daily. She spent 5 days in ACH getting acute care and then was discharged into a postacute phase equivalent to outpatient monitoring called the restorative phase. She was monitored remotely for the duration of the restorative phase for 10 more days, and then she recovered fully. This case highlights that high-acuity patients with SBO can receive invasive treatments like NG tube suction as well as be appropriately monitored for clinical decompensation by a virtual hybrid home hospital program which combines virtual care providers with an in-home vendor-mediated supply chain.

AbstractGood physician–patient communication is key for effective hospital care. We describe a patient diagnosed with an acute pulmonary embolism and bacteremia who was treated in a virtual hybrid hospital‐at‐home program. Constant communication with the virtual and in‐home healthcare teams enabled a unified knowledge of the patient's wishes.

Chronically ill patients with superimposed acute illness requiring hospitalization are more likely to develop an extended length of stay, hospital-acquired infections, and adverse events throughout their hospitalization. An excellent alternative to managing this population of patients in the traditional bricks-and-mortal (BAM) hospital is the hospital-at-home (HaH) model. The Advanced Care at Home (ACH) program is Mayo Clinic’s HaH model that provides acute and postacute care to high-acuity patients in their homes rather than in the traditional hospital and skilled nursing facility. We report a case of postoperative care through the ACH program of a patient suffering from short gut syndrome, high-output ileostomy, and severe protein-calorie malnutrition in the setting of previously diagnosed triple-negative invasive ductal carcinoma (IDC) of the right breast complicated by lung and brain metastasis. The patient had multiple complications that required repeated scare escalations directed by a multidisciplinary virtual care. Despite these complications, the ACH model of care was able to keep the patient in the home setting the majority of the time, limiting BAM hospital days, and eliminating the need to use the emergency department for acute escalation for 3 months. The patient was able to recover during this time period and proceed to successful take-down of the ileostomy. This case highlights the benefits of the ACH program by offering high-acuity hospital-level care to severely ill patients in the comfort of their homes. Highly qualified providers paired with curated technology in the home allowed for prompt identification of patient decompensation and timely initiation of treatment while avoiding institutionalization.

Introduction The Care Hotel is a virtual hybrid care model for postoperative patients after low-risk procedures which allow recovery in an outpatient environment. This study aimed to analyze if the American Society of Anesthesiologists Physical Status (ASA PS) Classification System can be used as a predictive factor for staying at Mayo Clinic’s Care Hotel. Methods This retrospective cohort study was conducted between July 23, 2020, and June 4, 2021, at Mayo Clinic in Florida, a 306-bed community academic hospital. ASA PS Class and post-procedure care setting (Care Hotel vs inpatient ward) were collected. Patients were classified into two ASA PS groups (ASA PS Classes 1-2 and 3-4). Pearson’s Chi-square test was used to determine if the ASA PS Class and having stayed or not at the Care Hotel were independent and an Odds Ratio (OR) calculated. Results Out of 392 surgical and procedural patients, 272 (69.39%) chose the Care Hotel and 120 (30.61%) chose the inpatient ward. There was a statistically significant association between ASA PS Class and staying at the Care Hotel, P < .01. The OR of preferring to stay at the Care Hotel in patients with ASA PS Class 1-2 vs ASA PC Class 3-4 was 1.91 ( P = .0041, 95% CI: 1.229-2.982) Conclusion Patients with ASA PS Classes 1-2 are almost twice as likely to elect to stay at the Care Hotel compared to those with ASA PS Classes 3-4. This finding may help care teams focus their Care hotel recruitment efforts.

Objectives: Traditional hospital at home models often have high patient experience scores. The purpose of this study is to look at the patient experience of a new virtual hybrid model of hospital at home called Advanced Care at Home. Methods: Patients in Mayo Clinic’s Advanced Care at Home program received a survey via email from 1 January–31 May 2021. Each survey consisted of 20 questions divided into 18 multiple-choice and two open-ended questions. Results: Ninety-nine surveys were sent and 41 partially or completely finished surveys were returned for a response rate of 41.4%. Patients responded positively, denoted by answering “strongly agree or somewhat agree,” with regard to the ability to reach the team right away 100% of the time, being kept informed 92% of the time, the command center responding promptly to their needs 95% of the time, the team providing comfort and support 98% of the time, feeling comfortable with interacting with their provider by phone or tablet 95% of the time, the ease of use from the equipment 97% of the time, the virtual and in-person staff working well together 98% of the time, the staff treating patients with courtesy and respect 100% of the time, and the ease of understanding the discharge process and feeling ready to leave the program 100% of the time. All providers received positive responses on listening ⩾88% of the time. Patients gave a top rating in likelihood to recommend the program 100% of the time. Conclusion: Overall, the Advanced Care at Home model of hospital at home was highly recommended by patients. Patients scored the program high on responsiveness, staff engagement and communication, ease of equipment use, and readiness for discharge, strengthening the overall confidence in this novel program.