Posted by: Duke Raleigh Hospital | April 19, 2021

Program Provides Hospital Level Care at Home

For Marilyn Moore, 83, the news of another pneumonia diagnosis left her dreading her next hospital admission. That is until physicians providing Moore care in the Duke Raleigh Hospital Emergency Department approached Moore with an alternative.

Moore could be admitted into the Duke Raleigh Acute Hospital Care at Home Program. This program, which partners Duke Raleigh Hospital, the Duke Institute for Health Innovation and Duke HomeCare and Hospice, allows patients admitted to Duke Raleigh Hospital who meet specific health criteria to be transported back to their homes for hospital-level care.

“The minute this option was brought up I said “yes!,” said Linda Bustillos, Moore’s daughter and caregiver. “I knew she would thrive at home.”

Patients in the program submit to secure remote monitoring of their pulse, heart rhythm and other vital signs. Members of the Duke Raleigh Hospital Medicine care team are alerted to any changes in the patient’s health. A physician visits the home at least once a day and a nurse visits at least twice a day to provide in-person care.

Marilyn Moore, 83, receives care for a pneumonia diagnosis in her home through the Duke Raleigh Acute Hospital Care at Home Program.

“After meeting Ms. Moore in the Emergency Department and speaking with her daughter, Linda, I knew this would be the perfect environment for Marilyn to receive care,” said Dr. Vidhya Aroumougame, who helped provide Moore’s care and serves as the program’s clinical lead. “While she was admitted to our program, I saw how happy and comfortable she was at home, which warmed my heart. I also enjoyed an enhanced patient-physician interaction.”

Medications are provided in the home by the Duke Raleigh Hospital inpatient Pharmacy and Home Infusion and labs are taken and transported back to the hospital for processing. At the patient’s request, daily delivery of hospital meals to the patient’s home is also offered.

“Our expectation is that this program will increase care access during periods of high inpatient and emergency department volume, decrease the total cost of care for our community, and improve the patient experience,” said Dr. Michael Spiritos, chief medical officer at Duke Raleigh Hospital.

Dr. Vidhya Aroumougame, a hospitalist at Duke Raleigh Hospital and program clinical lead, discusses Moore’s care at her home April 16.

For Moore, who says she’s only left her home nine times since the COVID-19 pandemic began, the experience was a perfect fit. After she was admitted, she says it was a great feeling to walk out of the ambulance and into her front door for care.

“It was nice to have people in the house again,” Moore said, as she sat on her living room sofa surrounded by family photos and a mantle adorned with tinkle lights. “Cynthia and Justin [nurses] are wonderful people, wonderful. They were caring and loving. The doctors were very fantastic. We even got their telephone number. This was a whole new experience for us.”

The ability to keep up with the routine that Moore was used to in a familiar environment made it easier on both Bustillos and Moore.

“She does really well with a routine, and I knew at home she could have her routine,” Bustillos added. “The more we can keep the routines the same the better the outcome. She likes her home, she’s comfortable here. This program has been wonderful for her. The whole experience has enabled me to get involved in my mom’s care in a totally different way.”

Moore was the first patient admitted to the Duke Raleigh Acute Hospital Care at Home Program. To be eligible for the program, patients must live within ten miles of Duke Raleigh Hospital, be insured by Medicare or Aetna Medicare Advantage, and have one of the following conditions: worsening asthma, skin infection (cellulitis), congestive heart failure, worsening chronic obstructive pulmonary disease, pneumonia, or urinary tract infection.

“The hospital-at-home service not only meets patients where they are physically, but also provides emotional warmth, familiarity, and a safety in a time when people have felt isolated,” said Will Knechtle, innovation program manager, Duke Institute for Health Innovation. “The Duke Institute for Health Innovation and the Duke Raleigh Hospital team launched this service with the conviction that healthcare must be innovated not only within the walls of hospitals, but also in our connections to community.”

–By Erin McKenzie

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