Die Einführung von „Hospital-at-Home“-Programmen konzentriert sich weiterhin auf größere, städtische, gemeinnützige und akademische Krankenhäuser. Die Studie unterstreicht die Notwendigkeit gezielter Anreize zur Ausweitung des Programms auf kleinere, ländliche und nicht lehrende Krankenhäuser.
https://www.uclahealth.org/news/release/adoption-hospital-home-programs-remains-concentrated-among
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Hospital-at-home programs deliver care for acute medical illness to selected patients in their home in lieu of traditional hospital admission. The growth of hospital-at-home programs in the US progressed slowly until the Centers for Medicare & Medicaid Services (CMS) established the Acute Hospital Care at Home (AHCAH) program in November 2020. Through this program, hospitals may apply to CMS for a waiver that allows them to receive full diagnosis-related group payments for hospital-at-home admissions. The goals of the program were to mitigate the hospital capacity crisis exacerbated by the COVID-19 pandemic and protect patients with non–COVID-19 illness who required hospital care.
[https://jamanetwork.com/journals/jama/article-abstract/2828411](https://jamanetwork.com/journals/jama/article-abstract/2828411)
The liability sounds crazy. How do you control for access to diet, aspiration risk, home safety, pt drug use, sobriety neighborhood safety, infiltrated IVs, decompensation needing ICU transfer, acute PE, ileus/SBO and worse anaphylaxis?
I have a feeling only certain zip codes get approved for this and then a study gets published saying outcomes are the same vs inpatient…and then people think this is a good idea and then a nurse or physician get stabbed, shot or attacked with no security or a pt doesn’t improve because something was missed.
Calling a consult is gonna decrease significantly!