scholarly journals Hospital at Home: An Evolving Model for Comprehensive Healthcare

2021 ◽  
Author(s):  
Henil Y. Patel ◽  
Daniel J. West
Keyword(s):  
Healthcare Services ◽  
The United States ◽  
Healthcare Management ◽  
Point Of View ◽  
Generation Model ◽  
Model Of Care ◽  
Treatment Protocols ◽  
Hospital At Home ◽  
The Impact ◽  
At Home

ABSTRACT Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.

scholarly journals Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Yi Feng Lai ◽  
Yee Wei Lim ◽  
Win Sen Kuan ◽  
Joel Goh ◽  
John Tshon Yit Soong ◽  
...  
Keyword(s):  
Home Environment ◽  
The United States ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Attitudes And Perceptions ◽  
Hospital At Home ◽  
Medical Wards ◽  
Survey Responses ◽  
At Home

Introduction: Hospital-at-Home (HaH) programmes are well-established in Australia, Europe, and the United States. However, there is limited experience in Asia, where the hospital is traditionally seen as a safe and trusted space for healing. This cross-sectional study aimed to explore attitudes and perceptions among patients and caregivers in Singapore toward this care model.Methods: A quantitative study design was adopted to collect data among patients and their caregivers from medical wards within two acute hospitals in Singapore. Using a series of closed-ended and open-ended questions, the investigator-administered survey aimed to explore barriers and facilitators determining patients' and caregivers' responses. The study questionnaire was pretested and validated. Data were summarised using descriptive statistics, and logistic regression was performed to determine key factors influencing patients' decisions to enrol in such programmes.Results: Survey responses were collected from 120 participants (101 patients, 19 caregivers; response rate: 76%), of which 87 respondents (72.5%) expressed willingness to try HaH if offered. Many respondents valued non-quantifiable programme benefits, including perceived gains in quality of life. Among them, reasons cited for acceptance included preference for the comfort of their home environment, presence of family members, and confidence toward remote monitoring modalities. Among respondents who were unwilling to accept HaH, a common reason indicated was stronger confidence toward hospital care.Discussion: Most patients surveyed were open to having acute care delivered in their home environment, and concerns expressed may largely be addressed by operational considerations. The findings provide useful insights toward the planning of HaH programmes in Singapore.

scholarly journals Closing Time! Examining the Impact of Gender and Executive Branch Policy Makers on the Timing of Stay-at-Home Orders

2020 ◽  
Vol 16 (4) ◽  
pp. 935-942 ◽  
Author(s):  
Laine P. Shay
Keyword(s):  
Event History Analysis ◽  
Health Agency ◽  
The United States ◽  
Executive Branch ◽  
Female Leadership ◽  
Closing Time ◽  
Policy Makers ◽  
History Analysis ◽  
The Impact ◽  
At Home

AbstractThe 2019–20 coronavirus pandemic has significantly altered lives across the globe. In the United States, several states attempted to manage the pandemic by issuing stay-at-home orders. In this research note, I examine whether the gender of state policy makers in the executive branch might impact a state's adoption of a stay-at-home order. Using event history analysis, I find that the governor's gender has no impact on the likelihood of a state adopting a stay-at-home order. However, I find that gender plays a significant role for agency heads. Specifically, my analysis shows that states with a female-headed health agency tend to adopt stay-at-home orders earlier than states with a male administrator. These findings shed light on how female leadership in the executive branch may impact public policy regarding COVID-19.

Keurig: From David to Goliath: The Challenge of Gaining and Maintaining Marketplace Leadership

2017 ◽  
pp. 1-16
Author(s):  
Eric T. Anderson ◽  
Elizabeth Anderson
Keyword(s):  
Vice President ◽  
The United States ◽  
Growth Potential ◽  
Green Mountain ◽  
Publicly Traded ◽  
Key Technology ◽  
Machine Manufacturer ◽  
Wholly Owned Subsidiary ◽  
The Impact ◽  
At Home

From 2002 to 2011, coffee-machine manufacturer Keurig Incorporated had grown from a privately held company with just over $20 million in revenues and a plan to enter the single serve coffee arena for home consumers, to a wholly owned subsidiary of Green Mountain Coffee Roasters, Inc., a publicly traded company with net revenues of $1.36 billion and a market capitalization of between $8 and $9 billion. In 2003 Keurig had introduced its first At Home brewer. Now, approximately 25 percent of all coffee makers sold in the United States were Keurig-branded machines, and Keurig was recognized as among the leaders in the marketplace. The company had just concluded agreements with both Dunkin' Donuts and Starbucks that would make these retailers' coffee available for use with Keurig's specialized brewing system. The company faced far different challenges than when it was a small, unknown marketplace entrant. John Whoriskey, vice president and general manager of Keurig's At Home division, had to consider the impact that impending expiration of key technology patents and the perceived environmental impact of the K-Cup® portion packs would have on the company's growth. Whoriskey also wondered what Keurig's growth potential was, and how the new arrangements with Starbucks and Dunkin' Donuts could be leveraged to achieve it.

scholarly journals Czesław Miłosz’s Migrant Perspective in Rodzinna Europa [Native Realm]

2017 ◽  
Vol 1 (1) ◽  
pp. 342-349
Author(s):  
Ewa Kołodziejczyk
Keyword(s):  
United States ◽  
William Faulkner ◽  
Religious Diversity ◽  
The United States ◽  
Point Of View ◽  
European Perspective ◽  
Central European ◽  
New Perspective ◽  
Post War ◽  
The Impact

Abstract The article traces the impact of Czesław Miłosz’s first American stay on his image of Central Europe in Rodzinna Europa [Native Realm]. In the United States, the post-war immigrant from Vilnius learned to perceive, understand and evaluate American culture; he also gained a new perspective on his region of Europe and Slavic immigrants. This experience enabled him to adopt an American point of view in his autobiographical essay. Following William Faulkner, Miłosz carries on an analysis of Eastern and Central Europe’s history and identities. The uses Western historical and sociological glossary to describe processes that formed his “native realm.” Analogically, the poet from pre-war Vilnius reflects on American multi-ethnicity and religious diversity from a Central European perspective. In Rodzinna Europa, Miłosz takes the position of a migrant translator and a two-way mediator between East and West.

scholarly journals The Impact of Primary Care: A Focused Review

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-22 ◽  
Author(s):  
Leiyu Shi
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Negative Impact ◽  
Healthcare Services ◽  
The United States ◽  
Emergency Department Visits ◽  
Care Practice ◽  
Quality Healthcare ◽  
The Usa ◽  
The Impact

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

A Citizen's View of the Impact of Crime

1969 ◽  
Vol 15 (3) ◽  
pp. 323-332
Author(s):  
Julia D. Stuart
Keyword(s):  
Quality Of Life ◽  
Criminal Behavior ◽  
Fear Of Crime ◽  
The United States ◽  
Point Of View ◽  
Corrosive Effect ◽  
And Behavior ◽  
Direct Encounter ◽  
The Impact

What is the impact of crime on the average individual in this country? What is the impact of the fear of crime on the quality of life in the United States? These questions are addressed in this article not from the point of view of an expert, or of an official in the criminal justice system, or of a victim of crime, but from that of an average person whose experience has included no direct encounter with crime of any kind. Those who have been victims of crime and those affected even indirectly by criminal behavior will react, naturally, with predictable concern; crime also has discernible effects on the attitudes and behavior of people generally, and this impact in turn has a corrosive effect on the quality of life in America.

scholarly journals Positive impact of facility-based isolation of mild COVID-19 cases on effectively curbing the pandemic: a mathematical modelling study

2020 ◽  
Author(s):  
Simiao Chen ◽  
Qiushi Chen ◽  
Juntao Yang ◽  
Lin Lin ◽  
Linye Li ◽  
...  
Keyword(s):  
United States ◽  
Positive Impact ◽  
High Capacity ◽  
The United States ◽  
Sensitivity Analyses ◽  
Effective Capacity ◽  
Home Based ◽  
Primary Model ◽  
The Impact ◽  
At Home

Abstract Background In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We aim to examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the United States. Methods We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the United States from March to September. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. The primary model outcomes included the reduction of new infections and deaths over two months from October onwards. We further explored different effects of facility-based isolation under different epidemic burdens by major US Census Regions, and performed sensitivity analyses by varying key model assumptions and parameters. Results We projected that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% Credible Interval 1.65–7.11) million new infections and 16 000 (8000-23 000) deaths in two months compared with home-based isolation, equivalent to relative reductions of 57% (44–61%) in new infections and 37% (27–40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population would achieve greater reduction of 76% (62–84%) in new infections and 52% (37–64%) in deaths when supported by the expanded testing with a 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions. Conclusion Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic compared to home-based isolation. The local epidemic burden should determine the effective scale of facility-based isolation strategies.

A systematic literature review of the impact of 5-HT3RA use on health care utilization in patients with chemotherapy-induced nausea and vomiting in the United States.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 269-269
Author(s):  
Michael S. Broder ◽  
Claudio Faria ◽  
Annette Powers ◽  
Jehangeer Sunderji ◽  
Dasha Cherepanov
Keyword(s):  
Rescue Medication ◽  
Human Subjects ◽  
Healthcare Services ◽  
The United States ◽  
Nausea And Vomiting ◽  
Care Utilization ◽  
Outpatient Services ◽  
Medical Subject Headings ◽  
Inpatient Services ◽  
The Impact

269 Background: Uncontrolled chemotherapy-induced nausea and vomiting (CINV) can lead to nutrient depletion, diminished function, disruption of chemotherapy, and increased costs. Standard antiemetic therapy includes 5-HT3RAs for CINV prophylaxis, with palonosetron recommended in National Comprehensive Cancer Network (NCCN), Multinational Association of Supportive Care in Cancer (MASCC), and ASCO guidelines as the preferred 5-HT3RA for CINV prophylaxis with MEC. There is evidence that using 5-HT3RAs can reduce costs but no comprehensive review of the evidence is available. Methods: We searched MEDLINE, National Institute for Health Research (NIHR), Centre for Reviews and Dissemination (CRD databases, 4 conferences (Academy of Managed Care Pharmacy, ASCO, International Society for Pharmacoeconomics and Outcomes Research, MASCC), and bibliographies of included articles. We queried Medical Subject Headings (MeSH) and key terms: “ondansetron,” “granisetron,” “palonosetron,” “dolasetron mesylate,” “costs,” “cost analysis,” and “economics.” Included records reported data on cost/utilization (rescue medication, outpatient/inpatient services) related to 5-HT3RA use for CINV in English, in human subjects, and published after 1997. Results: Of the 433 identified records, the 16 reporting utilization in the US were reviewed (excluded: 29 duplicates, 388 off-topic records). Studies varied significantly in designs, patients, 5-HT3RA regimens, and definition of outcomes. Twelve studies reported rescue medication use for CINV in patients using different 5-HT3RAs. In 5 studies, fewer patients treated with palonosetron required rescue medication versus ondansetron users (56% vs. 61%, 28% vs. 83%, 14% vs. 24%, 8% vs. 11%, 6% vs. 11%); 2 studies found palonosetron users had fewer outpatient services versus ondansetron users (5% vs. 10%, 8% vs. 10%). Four studies, with a variety of patients and outcomes, reported fewer patients treated with palonosetron versus ondansetron or other 5-HT3RAs used inpatient care (e.g., 0.2% vs. 0.4%, 16% vs. 23%, 7% vs. 10%, 0% vs. 5%), while 2 studies reported similar use (1% vs. 1%, 0% vs. 0%). Conclusions: CINV prophylaxis with palonosetron is generally associated with lower use of rescue medications, outpatient and inpatient services compared to ondansetron or other 5-HT3RAs. Use of palonosetron as a standard treatment may lead to reduced utilization of rescue medications and healthcare services for CINV and subsequent cost savings.

Hospital at Home Treatment of Haematological Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4686-4686
Author(s):  
Gianluca Isaia ◽  
Nicoletta Aimonino Ricauda ◽  
Marco A Astengo ◽  
Marco Ladetto ◽  
Renata Marinello ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
The United States ◽  
World Health ◽  
Minor Stroke ◽  
Haematological Patients ◽  
Hospital At Home ◽  
Lymphatic Cell ◽  
At Home

Abstract In the Western World, health care systems are facing the challenge of providing high quality services in a cost effective fashion (Madgwick KV and Yardumian A 1999, Szterling LN 2005). At the same time, the number of old and frail patients is increasing. For these reasons, medical home services have been recently developed that can guarantee hospital-like assistance, with lower costs (Cartoni C et al 2007) and greater respect of patients’frailty. Despite the increasing number of haematological home services world-wide, the volume of out-of-hospital transfusions, in the United States, is estimated to be <1% of the total blood transfusions (Benson K 2006). Here, we present our Hospital at Home Service (HHS), together with a one-year serie (January 2007 to December 2007) of patients admitted for an acute illness and with a main or secondary diagnosis of haematological illness or requiring emocomponent transfusion. HHS is a service of the University Hospital of Torino, aiming to provide selected, acutely ill patients with a hospital-like assistance at their home. In this alternative setting of care, physicians and nurses work as a real mobile team, while the care-givers are educated to actively take part in the nursing of the patients. Blood tests, instrumental investigations (EKG, pulse oximetry, spirometry, abdominal, vascular and cardiac ultrasonography, radiograms), intravenous therapies, emocomponent transfusions, oxygen therapy and surgical treatment of pressure ulcers are performed at the patients’ home. As to transfusion of emocomponents at home, pre-transfusion blood samples are collected by a nurse the day before and the entire process is started by a physician and then monitored by a specialist nurse. Randomized controlled trials of patients affected by minor stroke, exacerbated heart failure and exacerbated COPD have been conducted (Aimonino Ricauda N et al 2004 and 2008), showing the non-inferiority and the higher cost-effectiveness of HHS as compared to admission to traditional hospital wards. In the present retrospective study general data, functional status (Activities of Daily Living – ADL, Instrumental Activities of Daily Living – IADL, Karnofsky performance status), comorbidity level (Cumulative Illness Rating Scale – CIRS) and severity of diseases (Acute Physiology and Chronic Health Evaluation – APACHE II) at admission, blood parameters and length of stay were collected. Over a total of 481 patients treated in 2007, 54 (11.2%) patients were enrolled on the basis of their diagnosis code at discharge: 4 (7.4%) with lymphatic cell neoplasia, 42 (77.7%) with anemia and 8 (14.8%) with anemia and lymphatic cell neoplasia. Mean age was 80.9 ± 9.6 years. Patients showed severe functional impairment and comorbidity. Mean length of stay was 26.04 ± 21.26 days. Thirty-five patients 41 (76%) were discharged at home, 3 (5.5%) were transferred to another hospital unit and 10 (18.5%) died. Thirty one (64.8%) needed an emocomponent transfusion, for a total of 112 blood units and 49 platelet pools. No adverse reactions were observed. The data presented show that a consistent proportion of the patients admitted to the HHS have a haematological illness. Even though we have no comparative data, our experience shows the feasibility of the treatment of selected haematological patients in a hospital-at-home setting of care.

scholarly journals Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association

Circulation ◽  
2020 ◽  
Vol 142 (4) ◽  
Author(s):  
Daichi Shimbo ◽  
Nancy T. Artinian ◽  
Jan N. Basile ◽  
Lawrence R. Krakoff ◽  
Karen L. Margolis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
The United States ◽  
White Coat ◽  
Policy Statement ◽  
Masked Hypertension ◽  
Financial Investment ◽  
Diagnosis And Management ◽  
The Impact ◽  
At Home

The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.

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