SHM Converge Scientific Abstract ePoster Gallery-Barriers to Admission to a Home Hospital Program

Pdf Summary

This report describes barriers to admission into UNC Health’s Advanced Care at Home (ACH) program, a “home hospital” model launched in August 2021. ACH delivers inpatient-level care in patients’ homes for individuals considered safe enough under the CMS Acute Care in the Home waiver. Care is provided through twice-daily in-person visits plus virtual physician and RN support from a 24/7 Mission Control team. By the time of reporting, the program had cared for 500 patients and saved 1,800 hospital bed days.<br /><br />To better understand why eligible patients were not admitted, ACH added a screening question to its EMR in April 2022. The study reviewed patients with eligible payors who lived within the program’s geographic service area, using chart review and, when needed, input from the clinical team or patient/family. Data were collected over five months (April–July 2022).<br /><br />A total of 5,044 screened-out patients had completed the questionnaire. The most common reason for exclusion was low acuity or observation status, affecting 1,178 patients (23.4%). Other frequent reasons included “Other” (591 patients, 11.7%) and high acuity (577 patients, 11.4%).<br /><br />The authors conclude that patients are excluded for many different reasons, and several represent opportunities to expand the reach of home hospital care. Potential improvements include advocating for CMS policy changes to allow observation status or skilled nursing facility care, and adding services such as telemetry or dialysis. The findings can help prioritize changes with the greatest potential to increase access to ACH.

Asset Subtitle

Michael Craig

Meta Tag

Author List Bailey Beauclair, Meera Udayakumar, Michael Craig

Category Research

Concept Advanced Care at Home Program

Concept Home Hospital Program

Concept Eligibility

Concept Screen-Out Reasons

Concept CMS Waiver

Distinguished Non-Finalist

Presenter Organization UNC School of Medicine

Presenting Author Michael Craig

Track Value in Hospital Medicine

Keywords

UNC Health

Advanced Care at Home

home hospital

admission barriers

CMS waiver

acute care at home

patient screening

hospital at home

eligibility criteria

telehealth support

Advanced Care at Home Program

Home Hospital Program

Eligibility

Screen-Out Reasons

CMS Waiver